Knee Injury and Knee Osteoarthritis -Development, evaluation and clinical application of patient-relevant questionnaires

The overall purpose was to evaluate patient-relevant outcomes in patients with knee injury and post-traumatic osteoarthritis of the knee. A self-administered questionnaire, The Knee injury and Osteoarthritis Outcome Score (KOOS) was developed by literature search, consulting an expert panel (including patients referred to physical therapy because of knee-related problems, orthopedic surgeons, and physical therapists both from Sweden and the USA), and a pilot study. Two validation studies were carried out, 21 patients were studied following reconstruction of the anterior cruciate ligament, and 142 patients were studied following knee arthroscopy. The KOOS proved to be a user-friendly and patient-relevant outcome measure with satisfactory metric properties. The KOOS was found reliable for assessment of groups and monitoring individuals. The KOOS was responsive to ACL reconstruction, physical therapy, and arthroscopic partial meniscectomy. The KOOS is available in two validated versions, for use in Sweden and the USA. The Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) is included in the KOOS. The WOMAC was translated into Swedish in three separate processes. A committee agreed on a mutual version that was tested for reliability and responsiveness in 52 subjects with arthroscopic knee OA undergoing arthroscopy. The metric properties were found satisfactory and comparable to the original version. The KOOS was more responsive than the WOMAC when evaluating subjects 20 years after meniscectomy. It is recommended that the KOOS subscales sport and recreation function and knee-related quality of life be added to the WOMAC when assessing post-traumatic OA. Three months after arthroscopic partial meniscectomy significant improvement was seen in patient-related outcomes, but substantial disability and handicap was still reported compared to reference groups. Twenty years after meniscectomy symptoms and functional limitations were reported, both in subjects with and without radiographic OA. Meniscectomized women reported worse symptoms and functional limitations than meniscectomized men, and compared to female controls. The relation between pain and radiographic OA was poor, 40 % of subjects with more severe OA did not report more pain than controls did. It is concluded that patient-relevant questionnaires, such as the KOOS, adds information and should be used, and be considered the primary outcome measure, in clinical trials of knee injury and knee OA