This author has approached the KNEEguru bulletin board members and elicited their co-operation in evaluating two scoring systems widely used by orthopaedic surgeons and researchers.
Her objective was to ask the people who had had a cartilage repair procedure to rate how each element of the scoring systems related to their own personal symptoms and disabilities.
Fifty-eight bulletin board members gave up their time to answer the online questionnaire. The questions were a consolidation of the questions of the IKDC and KOOS scoring systems, and the author later separated the results to allow a comparison of the two scoring systems. IKDC (International Knee Documentation Committee) and KOOS (Knee injury Osteoarthritis Outcome Score) are what are known as QOL (Quality of Life) scoring sytems and are used to measure the effect of the medical problem on the patient's quality of life as evaluated by the patient.
The study was undertaken because the authors have recognised that there is a problem in the field of medical research - researchers are trying to compare the outcomes of different types of treatment, but there is no standardisation of scoring systems, so it can be very difficult to decide whether one type of treatment is better than another. This is true also of QOL scoring systems. One of the scoring systems may be very relevant to cruciate ligament patients, for example, but less relevant to patients with cartilage damage.
Karen Hambly's special research interest is cartilage repair. She was aware of the paper published in 2007 (ref 1) where the author concluded that the most representative of the QOL scoring systems for knee patients in general were the IKDC and KOOS systems. The IKDC had been designed to measure symptoms, function, and sports activity in patients who have one or more of a variety of knee conditions, including ligament, meniscal, articular cartilage,arthritis, and patellofemoral injuries. The KOOS had been designed with the purpose of evaluating short-term and long-term symptoms and function in subjects with a variety of knee injuries that could possibly result in osteoarthritis. The authors set out in this study to determine which of these two scoring systems better reflected the specific concerns of the postoperative cartilage repair patient.
In addition to IKDC and KOOS, the authors also built into the questionnaire the elements of the Tegner scoring system. The Tegner evaluates the activity levels of the patient and also their involvement in sporting activities.
The carefully-designed survey (approved by the London Metropolitan University's ethics committee) was posted on the KNEEguru bulletin board. The 58 responses were analysed taking note of both the frequency of a symptom and also how important that symptom was to the patient. The results highlighted that although both the IKDC and the KOOS scoring systems had a large number of questions of relevance and importance to this postoperative articular cartilage repair patient group, the IKDC scoring system better reflected their concerns.
Hambly K and Griva K. IKDC or KOOS? Which Measures Symptoms and Disabilities Most Important to Postoperative Articular Cartilage Repair Patients?. Am J Sports Med. 2008;e-publication ahead of print.
1 Tanner SM, Dainty KN, Marx RG, Kirkley A. Knee-specific quality-oflife instruments: which ones measure symptoms and disabilities most important to patients? Am J Sports Med. 2007;35(9):1450-1458.