Clinical outcome measures in anterior cruciate ligament reconstruction: Clinician vs patient completed knee scores

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Introduction: Clinical outcome measures are important in both the conduct of clinical research and evaluation of knee surgery in every day clinical practice. A wide variety of validated outcome scores are available in the literature. The objective of this study was to investigate if there is a difference between clinician-completed and patient-completed outcome scores in detecting improvement following anterior cruciate ligament (ACL) reconstruction. 

Methods: Fifty patients with ACL rupture were prospectively evaluated using nine clinical outcome measures. Five clinician-completed knee scores included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score and Tapper and Hoover Meniscal Grading Score. Four patient-completed knee scores included IKDC Subjective Knee Score, Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form-12 Item Health Survey (SF-12) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Thirty-four of the 50 patients underwent an ACL reconstruction and were reassessed with all nine outcome scores upon their follow-up review 3 months post-operatively. 

Results: A significant longitudinal improvement was observed of all five clinician-completed knee scores including Tegner (3.3–4.1 (p = 0.006)), Lysholm (71.7–85.3 (p < 0.001)), Cincinnati (62.6–75.9 (p < 0.001)), IKDC Objective (Abnormal to Nearly Normal (p = 0.001)) and Tapper and Hoover (Fair to Good (p < 0.001)). However, none of the four patient-completed knee scores revealed a statistically significant improvement post-operatively. 

Conclusions: Results of clinician-completed scores were found to be inconsistent with those of patient-completed instruments. It's important to consider the mode of administering outcome measures either for research or clinical practice as it can have a significant influence on the end results. The use of both a clinician-completed and a patient-completed instrument maybe the more prudent approach to assessing and quantifying ACL injuries and the outcome post-operatively. Ultimately, better methods of objectively evaluating surgical interventions of the knee are required.

Original languageEnglish
Pages (from-to)e353-e360
Number of pages8
JournalThe Surgeon
Issue number6
Early online date24 Oct 2020
Publication statusPublished - Dec 2021


  • Anterior cruciate ligament
  • Clinician-completed
  • Knee scores
  • Patient reported outcome measures
  • Patient-completed
  • Reconstruction

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