Systematic Review
International Knee Documentation Committee Knee Survey Use After Anterior Cruciate Ligament Reconstruction: A 2005-2012 Systematic Review and World Region Comparison

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Purpose

The purpose of this review was to evaluate International Knee Documentation Committee (IKDC) survey use after anterior cruciate ligament reconstruction compared with other surveys and determine evidence levels and methodologic study quality by world region.

Methods

The Medline database was searched from January 2005 through December 2012.

Results

We identified 421 studies and 33 surveys. Europe and Australia had more objective and subjective IKDC form use (χ2 = 9.6, P = .047). Europe and Asia had more objective IKDC form use (χ2 = 19.4, P = .001). Asia had more Lysholm knee scale use (χ2 = 29.9, P < .0001). Europe had more Tegner Activity Level scale (χ2 = 31.7, P < .0001) and Knee Injury and Osteoarthritis Outcome Score2 = 20.5, P < .0001) use. North America and Australia had more Cincinnati or Noyes knee rating scale use (χ2 = 21, P < .0001). Asia and Australia had more studies with greater than 60 subjects (χ2 = 24.4, P = .018). Europe had more studies with greater than 24 months' follow-up (χ2 = 18.4, P = .018). Asia had more studies with adequate surgical descriptions (χ2 = 33.2, P < .0001). North America had more studies with well-described rehabilitation (χ2 = 18.2, P = .02). Europe had more studies with confirmed recruitment (χ2 = 12.9, P = .012). Australia and North America had more studies with confirmed independent investigators (χ2 = 11.1, P = .026). Europe had more studies with greater than 80% recruitment (χ2 = 16.0, P = .04). Methodologically stronger studies used the objective IKDC survey (P < .0001), the objective and subjective IKDC survey (P = .002), or the Cincinnati or Noyes scale (P = .002). This group also made greater use of the Tegner scale (P = .013).

Conclusions

Objective and subjective IKDC form use is comparable with Lysholm and Tegner scale use. Objective and subjective IKDC form use in combination with the Tegner Activity Level scale is recommended.

Level of Evidence

Level IV, systematic review of Level I-IV studies.

Section snippets

Methods

A systematic literature review was performed using Ovid to search the Medline database from January 2005 through December 2012. This 8-year period was considered representative of a period during which both the objective and subjective IKDC knee survey components were widely available. The key search term “anterior cruciate ligament” was combined with other terms including “reconstructive surgical procedures or reconstruction” and “outcome assessment (health care) or outcome and process

Results

We identified a total of 421 studies that met the inclusion criteria (Appendix References, available at www.arthroscopyjournal.org). The studies were well dispersed over the systematic review period (2005, 9.3%; 2006, 13.1%; 2007, 11.6%; 2008, 13.1%; 2009, 10.9%; 2010, 11.6%; 2011, 16.9%; and 2012, 13.5%). Evaluated studies were representative of many world regions: Asia, 26.4% of studies; Europe, 45.4%; North America, 19.5%; Australia, 7.1%; and South America, 1.7%. The overall study evidence

Discussion

As expected, the MCMS differed among studies of varying evidence levels. This validates the review procedures we used to score studies. A total of 33 different survey types were identified in the studies included in this systematic review. Among the surveys used by at least 5% of the studies, significant use pattern differences were observed among different world regions. Europe and Australia showed greater use of both the objective and subjective IKDC forms. Europe and Asia displayed greater

Conclusions

Objective and subjective IKDC form use is comparable with Lysholm knee score and Tegner Activity Level scale use. The strengths and weaknesses of methodologic ACL patient outcome research study quality differed by world region. Information such as this should help improve the quality of knee research in both established and developing areas. We recommend use of the combined objective and subjective IKDC criteria in combination with the Tegner Activity Level scale on the basis of research

Acknowledgment

The authors thank Dr. James Jay Irrgang of the University of Pittsburgh for his generous assistance during study development.

References (19)

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Note: To access the supplementary material accompanying this report, visit the November issue of Arthroscopy at www.arthroscopyjournal.org.

The authors report the following potential conflict of interest or source of funding: J.N. receives support as follows: Journal of Orthopaedic and Sports Physical Therapy Board President but non-funded. J.C.B. receives support as follows: Associate Editor, Arthroscopy Journal.

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