Lysholm score and Tegner activity level in individuals with normal knees.

BACKGROUND: The Lysholm score and Tegner activity scale are commonly used to document outcomes after arthroscopic knee surgery. These outcomes measurements are subjective in nature and evaluate performance and activity restrictions both before and after surgery, making them a valuable research tool when judging the effectiveness of surgical treatment. PURPOSE: To establish a normal knee data set for the Lysholm and Tegner rating systems, as well as to show how these scores are affected by age and gender. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A subjective questionnaire that included both the Lysholm score and Tegner activity grading scale was completed by 488 subjects in the community who considered their knee function normal. Any subject reporting a history of injury or surgery was excluded from the study. The average age was 41 years (range, 18-85), with 244 men and 244 women qualifying for statistical analysis. RESULTS: The average Lysholm score was 94 (range, 43-100), and the average Tegner activity level was 5.7 (range, 1-10). The Lysholm score and age demonstrated no correlation. The Tegner activity level was inversely correlated with age. The average Tegner activity level for men was 6.0, and the average activity scale for women was 5.4. There was no significant difference in the Lysholm score between men and women. CONCLUSION: These data acquired from a normal, healthy population provide a standard point of reference for the injured or postsurgical knee. These data also serve as ideal tools when counseling patients about realistic expectations after surgery, based on age and gender.

Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction.

BACKGROUND: Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction have not been established. HYPOTHESIS: Relationships exist between objective and subjective assessments after anterior cruciate ligament reconstruction. STUDY DESIGN: Case series. METHODS: Patients (N = 202) undergoing anterior cruciate ligament reconstruction with 2-year minimum follow-up were studied. Objective variables of ligament stability at follow-up included instrumented laxity, Lachman examination, and pivot-shift examination. Subjective variables of symptoms at follow-up included pain, swelling, giving way, locking, crepitus, stiffness, and limping. Subjective function at follow-up included walking, squatting, stair climbing, running, cutting, jumping, twisting, activity limitation, sports level, activities of daily living level, work level, knee function, sports participation, Lysholm score, and satisfaction with outcome. RESULTS: Instrumented knee laxity and Lachman examination had no significant (P >.05) relationships with any subjective variables of symptoms and function. Pivot-shift examination had significant associations with satisfaction (P =.03), partial giving way (P =.01), full giving way (P =.01), difficulty cutting (P =.01), difficulty twisting (P =.01), activity limitation (P =.01), overall knee function (P =.03), sports participation (P =.02), and Lysholm score (P =.01). CONCLUSIONS: The pivot-shift examination may be a better measure of "functional instability" than instrumented knee laxity or Lachman examination after anterior cruciate ligament reconstruction.

Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis.

BACKGROUND: The optimal management strategy for acute Achilles tendon rupture is controversial. PURPOSE: To determine the optimal management by using expected-value decision analysis. STUDY DESIGN: Cross-sectional study. METHODS: Outcome probabilities were determined from a systematic literature review, and patient-derived utility values were obtained from a visual analog scale questionnaire. A decision tree was constructed, and fold-back analysis was used to determine optimal treatment. Sensitivity analyses were used to determine the effect of varying outcome probabilities and utilities on decision-making. RESULTS: Outcome probabilities (expressed as operative; nonoperative) were as follows: well (0.762; 0.846), rerupture (0.022; 0.121), major complication (0.030; 0.025), moderate complication (0.075; 0.003), and mild complication (0.111; 0.005). Outcome utility values were well operative (7.9), well nonoperative (7.0), rerupture (2.6), major complication (1.0), moderate complication (3.5), and mild complication (4.7). Fold-back analysis revealed operative treatment as the optimal management strategy (6.89 versus 6.30). Threshold values were determined for the probability of a moderate complication from operative treatment (0.21) and the utility of rerupture (6.8). CONCLUSIONS: Operative management was the optimal strategy, given the outcome probabilities and patient utilities we studied. Nonoperative management was favored by increasing rates of operative complications; operative, by decreasing utility of rerupture. We advocate a model of doctor-patient shared decision-making in which both outcome probabilities and patient preferences are considered.