Evaluation of knee ligament injuries with the IKDC form

  • E. Hefti
  • W. Müller
  • R. P. Jakob
  • H. -U. Stäubli


Various scoring systems have been proposed to quantify the disability caused by knee ligament injuries and to evaluate the results of treatment. None of these systems has found worldwide acceptance, mainly because all scoring systems attribute numerical values to factors that are not quantifiable, and then the arbitrary scores are added together for parameters not comparable with each other. For these reasons a group of knee surgeons from Europe and America met in 1987 and founded the International Knee Documentation Committee (1KDC). A common terminology and an evaluation form was created. This form is the standard form for all publications on results of treatment of knee ligament injuries. It is a concise one-page form. It includes a documentation section, a qualification section and a evaluation section. For evaluation there are four problem areas (subjective assessment, symptoms, range of motion and ligament examination). These are supplemented with four additional areas that are only documented but not included in the evaluation (compartmental findings, donor site pathology, X-ray findings and functional tests). The form can be used pre- and postoperatively and at follow-up. It has been specified that in any publication the minimum follow-up time for shortterm results should be 2 years, for medium-term results 5 years and for long-term results 10 years. The largest part of the sheet is the qualification section. It is called “qualification” section rather than “scoring” section because no scores are given. Each parameter is qualified as “normal”, “nearly normal”, “abnormal” or “severely abnormal”. This qualification is less subjective and emotional than “very good”, “good”, “fair” and “poor”. No knee and no knee function can be better than normal, and it is rather doubtful whether any knee, once operated on, can ever be “normal” again. For evaluation, the parameters of the four problem ares “subjective assessment”, “symptoms”, “range of motion” and “ligament examination”, are qualified for the group qualification. The worst qualification within the group gives the group qualification. The worst group qualification gives the final evaluation. If the knee is abnormal in any of the problem areas, it cannot be a “normal” knee. For chronic knee conditions there is also the possibility of evaluating the sum of levels of improvement or deterioration of all groups compared with the preoperative evaluation. The committee also recommends that terms describing knee ligament problems should be used according to the definitions of Noyes et al. [32]. The use of the IKDC evaluation form will reveal less favourable results than those evaluated with other current evaluation forms, because a still existing knee problem cannot be hidden with a high numerical score that is added up from other, unrelated parameters. It is to be hoped, however, that the use of this new form will enable us to compare treatment methods in various publications with each other.

Key words

Scoring systems Knee ligament injuries IKDC form 


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  1. 1.
    Amirault JD, Cameron JC, MacIntosh DL, Marks P (1988) Chronic anterior cruciate ligament deficiency. Long-term results of MacIntosh's lateral substitution reconstruction. J Bone Joint Surg [Br] 70:622–624Google Scholar
  2. 2.
    Andersson C, Gillquist J (1990) Instrumented testing for evaluation of sagittal knee laxity. Clin Orthop 256:178–184PubMedGoogle Scholar
  3. 3.
    Apley AG (1990) Assessment on assessment (editorial). J Bone Joint Surg [Am] 72:957–958Google Scholar
  4. 4.
    Arnold JA, Coker TP, Heaton LM, Park JP, Harris WD (1979) Natural history of anterior eruciate tears. Am J Sports Med 7:305–313PubMedGoogle Scholar
  5. 5.
    Barber SD, Noyes FR, Mangine RE, McCloskey JW, Hartman W (1990) Quantitative assessment of functional limitations in normal and anterior eruciate ligament deficient knees. Clin Orthop 255:204–214PubMedGoogle Scholar
  6. 6.
    Barrack RL, Bruckner JD, Kneisl J, Imman WS, Alexander AH (1990) The outcome of nonoperatively treated complete tears of the anterior cruciate ligament in active young adults. Clin Orthop 259:192–199PubMedGoogle Scholar
  7. 7.
    Benedetto KP (1992) Internationaler Knieuntersuchungsbogen Mitteilungen der Deutschsprachigen Arbeitsgemeinschaft für Arthroskopie no 4Google Scholar
  8. 8.
    Boszotta H, Helpersdorfer W, Freudenschuss B (1991) Die Bedeutung der Arthroskopie bei der Versorgung der anteromedialen Läsion des Kniegelenks. Ein Therapickonzept. Aktuel Traumatol 21:215–222Google Scholar
  9. 9.
    Daniel DM, Stone ML, Sachs R, Malcom L (1985) Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 13:401–407PubMedGoogle Scholar
  10. 10.
    Debrunner HU (1982) Orthopädisches Diagnostikum. Thieme, StuttgartGoogle Scholar
  11. 11.
    Delamertier RB, Hohl M, Hopp E (1990) Ligament injuries associated with tibial plateau fractures. Clin Orthop 250:226–233PubMedGoogle Scholar
  12. 12.
    Edixhoven P, Huiskes R, de Graaf R (1989) Anteroposterior drawer measurements in the knee using an instrumented test device. Clin Orthop 247:232–242PubMedGoogle Scholar
  13. 13.
    Feagin JA, Blake WP (1983) Postoperative evaluation and result recording in the anterior cruciate ligament reconstructed knee. Clin Orthop 172:143–147PubMedGoogle Scholar
  14. 14.
    Fink C, Hoser C (1991) Die Ruptur des vorderen Kreuzbandes. Eine Langzeituntersuchung operative versus konservative Therapie. Dissertation, University of InnsbruckGoogle Scholar
  15. 15.
    Forster IW, Warren Smith CD, Tew M AD (1989) Is the KT1000 knee ligament arthrometer reliable? J Bone Joint Surg [Br] 71:843–847Google Scholar
  16. 16.
    Freeman BL, Beaty JH, Haynes DB (1982) The pes anserinus transfer. A long-term follow-up. J Bone Joint Surg [Am] 64:202–207Google Scholar
  17. 17.
    Hefti F, Gaechter A, Jenny H Morscher E (1982) Replacement of the anterior cruciate ligament. A comparative study of four different methods of reconstruction. Arch Orthop Trauma Surg 100:83–94PubMedGoogle Scholar
  18. 18.
    Hefti F, Drobny T, Hackenbruch W, Kipfer W, Holzach P (1991) Dokumentation und Evaluation von Knieinstabilitäten. In: Jakob RP, Staeubli HU (eds) Kniegelenk und Kreuzbänder. Springer, Berlin Heidelberg New York, pp 138–144Google Scholar
  19. 19.
    Hefti FL, Drobny T, Hackenbruch W, Kipfer WC, Holzach P, Jakob RP, Mueller W, Staeubli HU (1992) Evaluation of knee ligament injuries. The OAK and IKDC forms. In: The knee and the cruciate ligaments. Jakob RP Staeubli HU (eds) Springer, Berlin Heidelberg New York, pp 134–142Google Scholar
  20. 20.
    Jakob RP, Hassler H, Staeubli HU (1981) Observations on rotatory instability of the lateral compartment of the knee: experimental studies on the functional anatomy and the pathomechanism of the true and the reversed pivot shift sign. Acta Orthop Scand 52 Suppl 191Google Scholar
  21. 21.
    Jakob RP, Staeubli HU, Deland JT (1987) Grading pivot shift. Objective tests with implications for treatment. J Bone Joint Surg [Br] 69:294–299Google Scholar
  22. 22.
    Jensen JE, Slocum DB, Larson RL, James SL, Singer KM (1983) Reconstruction procedures for anterior cruciate ligament insufficiency: a computer analysis of clinical results. Am J Sports Med 11:240–248PubMedGoogle Scholar
  23. 23.
    Kramer KL, Maichl FP (1993) Scores, Bewertungsschemata und Klassifikationen in Orthopaedie und Traumatologie. Thieme. StuttgartGoogle Scholar
  24. 24.
    Larson R (1974) Rating sheet for knee function. In: Smillie I (ed) Diseases of the knee joint. Churchill-Livingstone Edinburgh, pp 29–30Google Scholar
  25. 25.
    Lukianov AV, Gillquist J, Grana WA, DeHaven K (1987) An anterior cruciate ligament (ACL) evaluation format for assessment of artificial or autologous anterior cruciate reconstruction results. Clin Orthop 218:167–180PubMedGoogle Scholar
  26. 26.
    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedGoogle Scholar
  27. 27.
    Marshall JF, Fetto JF, Botero PM (1977) Knee ligament injuries. A standardized evaluation method. Clin Orthop 123:115–129PubMedGoogle Scholar
  28. 28.
    McQuade KJ, Sidles JA, Larson RV (1989) Reliability of the Genucom Knee Analysis System. A pilot study. Clin Orthop 245:216–219Google Scholar
  29. 29.
    Mueller W, Biedert R, Hefti F, Jakob RP, Munzinger U, Staeubli HU (1988) OAK knee evaluation. A new way to assess knee ligament injuries. Clin Orthop 232:37–50PubMedGoogle Scholar
  30. 30.
    Noyes FR, Grood ES, Suntay WJ, Butler DL (1983) The threedimensional laxity of the anterior cruciate deficient knee as determined by clinical laxity tests. Iowa Orthop J 3:32Google Scholar
  31. 31.
    Noyes FR (1987) The Noyes knee rating system. Cincinnati Sportsmedicine Research and Education Foundation. CincinnatiGoogle Scholar
  32. 32.
    Noyes FR, Grood ES, Torzilli PA (1989) The definition of terms for motion and position of the knee and injuries of the ligaments. Current concepts review. J Bone Joint Surg [Am] 71:465–472Google Scholar
  33. 33.
    Noyes FR, Barber SD, Mooar LA (1989) A rationale for assessing sports activity levels and limitations in knee disorders. Clin Orthop 246:238–249PubMedGoogle Scholar
  34. 34.
    Noyes FR, Barber SD, Mangine RE (1990) Bone patellar ligament-bone and fascia lata allografts for reconstruction of the anterior cruciate ligament. J Bone Joint Surg [Am] 72:1125–1136Google Scholar
  35. 35.
    Noyes FR, Mooar LA, Barber SD (1991) The assessment of work related activities and limitations in knee disorders. Am J Sports Med 19:178–188PubMedGoogle Scholar
  36. 36.
    Puddu G, Ferretti A, Conteduca F, Mariani PP (1988) Risultati della ricostruzione con il semitendinoso nelle lassità chroniche anteriori del ginocchio. G Ital Orthop Traumatol 14:189–196Google Scholar
  37. 37.
    Russe O, Gerhardt Y, King P (1972) An atlas of examination. Standard measurements and documentation in orthopaedics and traumatology. Huber, BernGoogle Scholar
  38. 38.
    Seto JL, Orofino AS, Morrissey MC, Medeiros JM, Mason WJ (1988) Assessment of quadriceps/hamstrings strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction. Am J Sports Med 16:170–180PubMedGoogle Scholar
  39. 39.
    Staeubli HU, Jakob RP (1990) Assessment of posterior instability of the knee near extension. J Bone Joint Surg [Br] 72:225–230Google Scholar
  40. 40.
    Staeubli HU, Jakob RP, Noesberger B (1985) Anterior-posterior knee instability and stress radiography. A prospective biomechanical analysis with the knee in extension. In: Perren SM, Schneider E (eds) Biomechanics-current interdisciplinary research. Nijhoff, The Hague, pp 397–402Google Scholar
  41. 41.
    Staeubli HU, Jakob RP, Noesberger B (1992) Anterior subluxation in knees with chronic anterior cruciate ligament insufficiency: a comparison of arthrometry and stressradiography. In: Jakob RP, Staeubli HU (eds) The knee and the cruciate ligaments. Springer, Berlin Heidelberg New York, pp 134–142Google Scholar
  42. 42.
    Straub T, Hunter RE (1988) Acute anterior cruciate ligament repair. Clin Orthop 227:238–250PubMedGoogle Scholar
  43. 43.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49PubMedGoogle Scholar
  44. 44.
    Witvoet J, Christel P (1985) Treatment of chronic anterior knee instabilities with combined intra- and extraarticular augmented with carbon-PLA fibres. Clin Orthop 196:143–153PubMedGoogle Scholar
  45. 45.
    Wroble RR, Van Ginkel LA, Grood ES, Noyes FR, Shaffer BL (1990) Repeatability of the KT 1000 arthrometer in a normal population. Am J Sports Med 18:396–399PubMedGoogle Scholar
  46. 46.
    Zarins B, Rowe CR (1986) Combined anterior cruciate ligament reconstruction using semitendinosus tendon and iliotibial tract. J Bone Joint Surg [Am] 68:160–177Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • E. Hefti
    • 1
  • W. Müller
    • 2
  • R. P. Jakob
    • 3
  • H. -U. Stäubli
    • 4
  1. 1.Orthopädische Universitätsklinik, KinderspitalBaselSwitzerland
  2. 2.Orthopädische KlinikKantonsspital BruderholzBruderholzSwitzerland
  3. 3.Orthopädische Universitätsklinik, InselspitalBerneSwitzerland
  4. 4.TiefenauspitalBerneSwitzerland

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