Webster Kate E, Agel Julie, Feller Julian A, Magnussen Robert, Arendt Elizabeth A
School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia.
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.
J ISAKOS. 2025 Jun;12:100899. doi: 10.1016/j.jisako.2025.100899. Epub 2025 May 9.
Various knee-related patient-reported outcome measures (PROMs) have been used for patients who undergo surgical treatment for patellofemoral instability. There has been limited evaluation of their suitability and no agreement about an optimal set of measures.
To evaluate the Knee injury and Osteoarthritis Outcome Score (KOOS) and published shorter versions to determine their suitability for patients with patellofemoral instability.
The study cohort consisted of patients who underwent surgical stabilization with medial patellofemoral ligament reconstruction for recurrent lateral patellar dislocations. The full KOOS was administered preoperatively and the 6, 12, and 24 months postoperative. Four short form versions were calculated: KOOS-12, KOOS-Physical Function, KOOS-Joint Replacement, and KOOS-Global. Floor and ceiling effects were determined (threshold >15%). Individual items were evaluated to identify where >67% of patients had preoperative responses of "≥ moderate" (demonstrating item relevance). The standardized response mean (SRM) was calculated to assess responsiveness from baseline to each postoperative assessment time, as well as between postoperative assessments.
289 patients completed the full KOOS at least once. No ceiling effects were present at any time point for the quality of life (QoL) or symptoms subscales, KOOS-12, or KOOS-global. Only 11 of the items passed the >67% threshold for item relevance. These included all Sport/Recreation (SR) and QoL items, as well as one item (knee stiffness after sitting/resting later in the day) from the symptom subscale and one item (pain frequency) from the pain subscale. Given these individual item results, a two-subscale "composite" score was calculated that included the 9 items of the KOOS SR and QoL subscales (KOOS-SR + QoL). Excellent responsiveness was seen for all preoperative to postoperative comparisons, especially the composite SR + QoL measure (SRM >1). Between 6- and 12-month assessments, the composite SR + QoL score was also shown to be the most responsive measure.
The composite KOOS SR + QoL score may be an improved option for measuring patient-related outcomes in this more active population, as it focuses on the most relevant constructs for this patient group. The full 42-item KOOS was shown to have limited applicability in this patient group.
Level II.
各种与膝关节相关的患者报告结局测量指标（PROMs）已用于接受髌股关节不稳定手术治疗的患者。对其适用性的评估有限，且对于最佳测量指标集尚无共识。
评估膝关节损伤和骨关节炎结局评分（KOOS）及其已发表的较短版本，以确定它们对髌股关节不稳定患者的适用性。
研究队列包括因复发性外侧髌骨脱位接受内侧髌股韧带重建手术稳定治疗的患者。术前及术后6、12和24个月进行完整的KOOS评估。计算了四个简短版本：KOOS-12、KOOS-身体功能、KOOS-关节置换和KOOS-总体评分。确定地板效应和天花板效应（阈值>15%）。对各个项目进行评估，以确定>67%的患者术前回答为“≥中度”的情况（证明项目相关性）。计算标准化反应均值（SRM），以评估从基线到每个术后评估时间以及术后评估之间的反应性。
289例患者至少完成了一次完整的KOOS评估。在生活质量（QoL）或症状子量表、KOOS-12或KOOS-总体评分的任何时间点均未出现天花板效应。只有11个项目通过了>67%的项目相关性阈值。这些项目包括所有运动/娱乐（SR）和QoL项目，以及症状子量表中的一个项目（当天晚些时候坐下/休息后的膝关节僵硬）和疼痛子量表中的一个项目（疼痛频率）。根据这些单个项目的结果，计算了一个两子量表的“综合”评分，包括KOOS SR和QoL子量表的9个项目（KOOS-SR + QoL）。术前与术后的所有比较均显示出良好的反应性，尤其是综合SR + QoL测量指标（SRM>1）。在6至12个月的评估中，综合SR + QoL评分也被证明是反应性最强的测量指标。
综合KOOS SR + QoL评分可能是在这个更活跃的人群中测量患者相关结局的一个改进选项，因为它关注的是该患者群体最相关的结构。完整的42项KOOS在该患者群体中的适用性有限。
二级。
