The Knee Injury and Osteoarthritis Outcome Score: shortcomings in evaluating knee function in persons undergoing ACL reconstruction

Zsidai, Bálint; Narup, Eric; Senorski, Eric Hamrin; Lind, Martin; Spalding, Tim; Musahl, Volker; Samuelsson, Kristian; Irrgang, James J.

doi:10.1007/s00167-022-06990-9

Cited by 11 publications

(17 citation statements)

References 29 publications

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“…17 The utility of the KOOS for patients with ACL tears has recently been called into question. 5,20,26 The KOOS is a region-specific (knee) measure not tailored to patients with ACL injuries. Although studies have reported adequate reliability of the KOOS in patients with ACL deficiency, 19,22 many of its questions have been critiqued for being ''too easy'' for high-functioning individuals, resulting in ceiling effects that make detecting differences among patients more difficult.…”

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confidence: 99%

Development and Preliminary Validation of the KOOS-ACL: A Short Form Version of the KOOS for Young Active Patients With ACL Tears

et al. 2023

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Background: The Knee injury and Osteoarthritis Outcomes Score (KOOS) is a widely used region-specific outcome measure for assessing patients of all ages with a variety of knee conditions. Use of the KOOS for young active patients with anterior cruciate ligament (ACL) tear has been called into question regarding its relevance and interpretability for this specific population. Furthermore, the KOOS does not have adequate structural validity for use in high-functioning patients with ACL deficiency. Purpose: To develop a condition-specific short form version of the KOOS that is appropriate for the young active population with ACL deficiency: the KOOS-ACL. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A baseline data set of 618 young patients (≤25 years old) with ACL tears was divided into development and validation samples. Exploratory factor analyses were conducted in the development sample to identify the underlying factor structure and to reduce the number of items based on statistical and conceptual indicators. Confirmatory factor analyses were conducted to check fit indices of the proposed KOOS-ACL model in both samples. Psychometric properties of the KOOS-ACL were assessed using the same data set, expanded to include patient data from 5 time points (baseline and postoperative 3, 6, 12, and 24 months). Internal consistency reliability, structural validity, convergent validity, responsiveness to change, floor/ceiling effects, and detection of treatment effects between surgical interventions (ACL reconstruction alone vs ACL reconstruction + lateral extra-articular tenodesis) were assessed. Results: A 2-factor structure was deemed most appropriate for the KOOS-ACL. Of 42 items, 30 were removed from the full-length KOOS. The final KOOS-ACL model showed acceptable internal consistency reliability (α = .79-.90), structural validity (comparative fit index and Tucker-Lewis index = 0.98-0.99; root mean square error of approximation and standardized root mean square residual = 0.04-0.07), convergent validity (Spearman correlation with International Knee Documentation Committee subjective knee form = 0.61-0.83), and responsiveness across time (significant small to large effects; P < .05). Conclusion: The new KOOS-ACL questionnaire contains 12 items and 2 subscales—Function (8 items) and Sport (4 items)—relevant to young active patients with an ACL tear. Use of this short form would reduce patient burden by more than two-thirds; it provides improved structural validity as compared with the full-length KOOS for our population of interest; and it demonstrates adequate psychometric properties in our sample of young active patients undergoing ACL reconstruction.

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confidence: 99%

Development and Preliminary Validation of the KOOS-ACL: A Short Form Version of the KOOS for Young Active Patients With ACL Tears

et al. 2023

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“…Additionally, large-scale epidemiologic studies have enabled the investigation of international differences in variables such as graft choice and surgical timing in ACL-R [30]. An emerging challenge in the domain of registry-based ACL research is to encourage registration of a standardized set of variables across registries, the collection of a more comprehensive list of variables, and the use of relevant, content-valid PROMs for functional outcome assessment [31].…”

Section: Epidemiologymentioning

confidence: 99%

“…The compliance with regard to reporting of PROMs can be difficult to achieve with these registries, and there is a constant need for balance between the response rate of the patients and the amount of data that can be collected [55]. Moreover, the collected data and follow-up times for each individual ACL registry are not identical allowing challenges for combining and comparing of data from different registries and subsequently making generalization of the study results more difficult [31]. Furthermore, most of the ACL registries are still using KOOS as a primary outcome, which has been previously reported to be an "inappropriate" PROM for ACL injuries [31,56,57].…”

Section: Strengths and Limitations With Registry Datamentioning

confidence: 99%

“…Moreover, the collected data and follow-up times for each individual ACL registry are not identical allowing challenges for combining and comparing of data from different registries and subsequently making generalization of the study results more difficult [31]. Furthermore, most of the ACL registries are still using KOOS as a primary outcome, which has been previously reported to be an "inappropriate" PROM for ACL injuries [31,56,57]. Thus, the KOOS has been reported to have a lack of responsiveness as well as including irrelevant content such as certain items in the subscales: pain and activities of daily living [58••, 59].…”

Section: Strengths and Limitations With Registry Datamentioning

confidence: 99%

“…High-quality registry data plays a crucial role in assessing the outcomes of ACL-R at the level of the national population. Suggestions to improve the future utility of registry data include recruitment of non-operatively treated patients with ACL injury, the conduction of registry-based RCTs, the use of validated PROMs specific to ACL injury, and international collaborations between existing and newly established ACL registries (Table 3) [31,61].…”

Section: Future Of Acl Research Based On Registry Datamentioning

confidence: 99%

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Scoping Review on ACL Surgery and Registry Data

Kaarre

Zsidai

Narup

et al. 2022

Curr Rev Musculoskelet Med

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Purpose of Review To present an overview of registry-based anterior cruciate ligament (ACL) research, as well as provide insight into the future of ACL registries. Recent Findings During the past decades, the ACL registries have had an important role in increasing our understanding of patients with ACL injuries and their treatment. The registry data has deepened our understanding of factors that have been associated with an increased risk of sustaining an ACL injury and for evaluation of treatment factors and their impact on patient-related outcomes. Recently, registry-based ACL research using artificial intelligence (AI) and machine learning (ML) has shown potential to create clinical decision-making tools and analyzing outcomes. Thus, standardization of collected data between the registries is needed to facilitate the further collaboration between registries and to facilitate the interpretation of results and subsequently improve the possibilities for implementation of AI and ML in the registry-based research. Summary Several studies have been based on the current ACL registries providing an insight into the epidemiology of ACL injuries as well as outcomes following ACL reconstruction. However, the current ACL registries are facing future challenges, and thus, new methods and techniques are needed to ensure further good quality and clinical applicability of study findings based on ACL registry data.

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Item‐reduced Forgotten Joint Score provides adequate psychometric properties in ACLR patients

Kekki,

Wörner,

Stålman

et al. 2024

J. exp. orthop.

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PurposeThe purpose of this study was to evaluate content validity, test–retest reliability, internal consistency, construct validity, responsiveness and floor/ceiling effects of Forgotten Joint Score (FJS) for assessing functions in activities of daily living (ADL) following anterior cruciate ligament reconstruction (ACLR) and perform an item reduction of FJS.MethodsSwedish‐speaking ACLR patients in one surgical clinic were eligible. Content validity was evaluated through patient responses and patient and expert clinician relevance ratings, omitting items with low relevance. Principal component factor analysis, Cronbach's ⍺, paired t test, correlations between FJS and Knee Injury and Osteoarthritis Outcome Score (KOOS), Cohen's d effect sizes (ESs) and standardized response mean (SRM) were used to evaluate internal consistency, test–retest reliability, construct validity and responsiveness. Floor/ceiling effects were calculated. FJS was expected to reveal one dominant factor, a Cronbach's ⍺ between 0.70 and 0.95, correlations >0.50 to all KOOS subscores, highest for ADL, moderate ES and SRM, floor/ceiling effects <15%.ResultsOne hundred and seventy‐six participants (103 for assessing internal consistency, construct validity, responsiveness and floor/ceiling effects; 73 for assessing test–retest reliability and content validity) were included. Item reduction yielded a nine‐item FJS (FJS‐9). FJS‐12 and FJS‐9 demonstrated sufficient content validity (95% confidence interval [CI], 2.5–3.1, respectively, 2.9–3.3). FJS‐9 was found unidimensional, and FJS‐12 was multidimensional. Cronbach's ⍺ was 0.94 for FJS, and the intraclass correlation coefficient > 0.90. FJS showed significant correlations >0.65 to all KOOS subscales, moderate ES and SRM > 0.50. No floor/ceiling effects were found.ConclusionFJS‐9 demonstrated adequate validity for the evaluation of joint awareness in ACLR patients and can be a valuable tool to assess ADL and joint awareness.Level of EidenceLevel III.

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The Knee Injury and Osteoarthritis Outcome Score: shortcomings in evaluating knee function in persons undergoing ACL reconstruction

Cited by 11 publications

References 29 publications

Development and Preliminary Validation of the KOOS-ACL: A Short Form Version of the KOOS for Young Active Patients With ACL Tears

Development and Preliminary Validation of the KOOS-ACL: A Short Form Version of the KOOS for Young Active Patients With ACL Tears

Scoping Review on ACL Surgery and Registry Data

Item‐reduced Forgotten Joint Score provides adequate psychometric properties in ACLR patients

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