My visit to Erasmus Medical Centre.


I visited the amazing research team today at Erasmus Medical Centre. This recently re built academic teaching hospital in Rotterdam has 11,000 staff, including  a large medical research faculty. This is the largest Medical Centre in the Netherlands and houses a children’s hospital, main multi trauma centre and medical school, the education centre of which has won several design awards. 


I was fortunate to meet with Dr Max Reijman, Physiotherapist, who is the primary investigator of many projects at Erasmus Medical Centre. We discussed appropriate patient completed outcome questionnaires to measure impairment post ACL injury.

As a clinician working closely with this population I would encourage you to read this abstract. I have previously been using the Knee Injury and Osteoarthritis Outcome Score (KOOS) as with many clinicians and researchers in the ACL field, but this publication challenges using this in the early stage post ACL injury.


The full article can be accessed in Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 29, No 4 (April), 2013: pp 701-715.

Knee Injury and Osteoarthritis Outcome Score or International Knee Documentation Committee Subjective Knee Form: Which Questionnaire Is Most Useful to Monitor Patients With an Anterior Cruciate Ligament Rupture in the Short Term?

Belle L. van Meer, M.D., Duncan E. Meuffels, M.D., Ph.D., Maaike M. Vissers, Ph.D., Sita M. A. Bierma-Zeinstra, Ph.D., Jan A. N. Verhaar, M.D., Ph.D.,Caroline B. Terwee, Ph.D., and Max Reijman, Ph.D.

Purpose: To evaluate which questionnaire, the Knee Injury and Osteoarthritis Outcome Score (KOOS) or the International Knee Documentation Committee Subjective Knee Form (IKDC subjective), is most useful to evaluate patients with recent anterior cruciate ligament (ACL) ruptures or those within 1 year of an ACL reconstruction.

Methods: Patients with recent (0-6 months) ACL ruptures or those with indications for ACL reconstruction were included. All patients completed the questionnaires shortly after trauma or preoperatively and again 1 year later. The KOOS has 5 subscales, each scored separately. The IKDC subjective consists of one total score. The following measurement properties of the KOOS and IKDC subjective were assessed: content validity (n 1⁄4 45), construct validity (n 1⁄4 100), test-retest reliability (n 1⁄4 50), and responsiveness (n 1⁄4 50).

Results: Regarding content validity, 2 KOOS subscales (Pain and Activities of Daily Living) were scored as nonrelevant. Two of the 18 questions on the IKDC subjective were assessed as nonrelevant. Only the KOOS subscale Sport and Recreation Function had acceptable construct validity (79% confirmation of the predefined hypotheses). None of the KOOS subscales had a sufficient score for responsiveness (<75% confirmation of the predefined hypotheses). The IKDC subjective scored acceptable for construct validity (84% confirmation of the predefined hypotheses) and responsiveness (86% confirmation of the predefined hypotheses). All KOOS subscales and the IKDC subjective had a reliability (intraclass correlation coefficient [ICC]) of 0.81 or higher.

Conclusions: The IKDC subjective is more useful than the KOOS questionnaire to evaluate both patients with recent ACL ruptures and those in the first year after ACL reconstruction. Level of Evidence: Level III, prognostic validation study.

The Clinical Translator: Monitoring a patient’s progress post ACL injury is important regardless of the management selected. Patient completed questionnaires assist to provide a more accurate insight to the patient’s perception of their knee function following ACL injury and can be used at intervals during the recovery period to evaluate progress.

The short and long-term effects of an ACL injury on a patients knee function differ. This research indicates the International Documentation Knee Committee Score (IKDC) may be more appropriate to use in the first 12-18 months post ACL injury as compared to the KOOS. The IKDC Knee forms are freely available on the AOSSM web site.

Interestingly my last blog discussed the ACL-QOL scored highest as endorsed by ACL patients compared to both the IKDC and the KOOS, however the IKDC was also rated favourably by ACL deficient patients. 

This is intended as an aid to the clinician to translate research findings into clinical practice but is my own opinion based on the available current research evidence and my clinical expertise and experience. Clinicians should consider if this advice is appropriate for them and use their own reasoning processes considering the individual patient in question

The Clinical Translator from PhysioEducators: "striving for excellence through innovation in Physio Education”