COSMIN database

Patient-reported outcome measures for the knee

Wang, D., Jones, M. H., Khair, M. M., and Miniaci, A.
In the past 20 years, there has been considerable growth in the number of knee instruments and rating scales designed to measure outcomes from the perspective of the patient. Only a few of these instruments have been evaluated for reliability, validity, and responsiveness. The purpose of this systematic review was to examine the psychometric evidence of patient-reported outcome measures for the knee and identify the best scores for specific knee conditions. A literature search was performed to retrieve references relating to the development and evaluation of knee-specific instruments. Twenty-four unique instruments were identified, and most have satisfactory evidence for internal (alpha > or = 0.82) and test-retest reliability (intraclass correlation coefficient > or = 0.80). Face/content validity was typically assessed during the item selection process, and construct validity was evaluated through strict hypothesis testing or correlations with other clinical measures. For many instruments, effect sizes and standardized response means measuring responsiveness were large (> or = 0.80) within disease-specific populations. Based on the psychometric data, recommendations include the Cincinnati Knee Rating System, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm Knee Score for anterior cruciate ligament (ACL) injuries, the Kujala Anterior Knee Pain Scale for anterior knee pain, the International Knee Documentation Committee (IKDC) Subjective Knee Form, KOOS, and Lysholm Knee Score for focal chondral defects, the Western Ontario Meniscal Evaluation Tool (WOMET) for meniscal injuries, and the KOOS for osteoarthritis (OA). Although the IKDC can be used as a general knee measure, no instrument is currently universally applicable across the spectrum of knee disorders and patient groups. Clinicians and researchers looking to use a patient-based score for measurement of outcomes must consider the specific patient population in which it has been evaluated. Using a diagnostic algorithm that measures the anatomic parts of the knee as separate constructs may solve this dilemma, allowing for measurement of treatment outcomes across patient groups and selection of the optimal clinical intervention.
J Knee Surg
1538-8506 (Print)
Publication year:
Symptom status:
Emotional state
Physical state
Functional status:
Cognitive/mental functioning
Physical functioning
Role functioning
Social functioning
Adults (18-65)
Children (0-18)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Injury, poisoning and certain other consequences of external causes
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
AAOS-SKS - Academy of Orthopaedic Surgeons Sports Knee Scale
AKPS - Anterior Knee Pain Scale [alias: KPS - Kujala Patellofemoral Score; Kujala Score]   
CKRS - Cincinnati Knee Rating System
EKFS - Edinburgh Knee Function Scale
FIQ - Funtional Index Questionnaire
IKDC Subjective Knee Form - International Knee Documentation Committee Subjective Knee Form (versions: IKDC-9; knee ligament standard evaluation form)
Knee Osteoarthritis Severity Scale
KneST - Knee Pain Screening Tool
KOOS - Knee injury and Osteoarthritis Outcome Score (versions: KOOS-Child; KOOS-Joint Replacement; KOOS-12; KOOS-PF - KOOS PatelloFemoral pain and osteoarthritis)   
KOS-AoDL - Knee Outcome Survey- Activities of Daily Living Scale
KPS - Knee Pain Scale
KQoL-26 - Knee Quality of Life 26-item
K-SES - Knee Selfefficacy Scale
LEAP - Lower Extremity Activity Profile
LEAS - Lower Extremity Activity Scale
Lysholm (Knee) Score   
Marx Activity Score
OKS - Oxford Knee Score   
PSS - Patellofemoral Pain Syndrome (PFPS) Severity Scale
QoL-ACL - Quality of Life Outcome Measure for Anterior Cruciate Ligament Deficiency
Tegner Score   
VAS Knee - Knee Visual Analog Scale
WIQ - Walking Impairment Questionnaire   
WOMET - Western Ontario Meniscal Evaluation Tool