Left	Right
Ankle (plantar/dorsi)	5/5	5/5
Knee (flex/ext)	5/5	4+/3 (Guarded)
Hip (flex/ext)	5/5	5/5

Range of Motion

Reduced flexion ROM (to 110 degrees) on Right knee due to localized joint effusion. Normal ROM at all other lower extremity joints.

Manual Ligamentous Testing

Gait Analysis

Patient has a mild antalgic gait patters with reduced velocity, mild right circumduction, reduced right knee flexion in swing phase, reduced step time on right leg.

Tissue Properties

Moderate localize inflammation.

2000 IKDC KNEE EXAMINATION

Click to open IKDC Knee Examination Form (PDF)

INSTRUCTIONS FOR THE 2000 IKDC KNEE EXAMINATION FORM

The Knee Examination Form contains items that fall into one of seven measurement domains. However, only the first three of these domains are graded. The seven domains assessed by the Knee Examination Form are:

1. Effusion

   An effusion is assessed by ballotting the knee. A fluid wave (less than 25 cc) is graded mild, easily ballotteable fluid – moderate (25-60 cc), and a tense knee secondary to effusion (greater than 60 cc) is rated severe.

2. Passive Motion Deficit

   Passive range of motion is measured with a gonimeter and recorded on the form for the index side and opposite or normal side. Record values for zero point/hyperextension/flexion (e.g. 10 degrees of hyperextension, 150 degrees of flexion = 10/0/150; 10 degrees of flexion to 150 degrees of flexion = 0/10/150). Extension is compared to that of the normal knee.

3. Ligament Examination

   The Lachman test, total AP translation at 70 degrees, and medial and lateral joint opening may be assessed with manual, instrumented or stress x-ray examination. Only one should be graded, preferably a “measured displacement”. A force of 134 N (30 lbs) and the maximum manual are recorded in instrumented examination of both knees. Only the measured displacement at the standard force of 134 N is used for grading. The numerical values for the side to side difference are rounded off, and the appropriate box is marked. The end point is assessed in the Lachman test. The end point affects the grading when the index knee has 3-5 mm more anterior laxity than the normal knee. In this case, a soft end point results in an abnormal grade rather than a nearly normal grade. The 70-degree posterior sag is estimated by comparing the profile of the injured knee to the normal knee and palpating the medial femoral tibial stepoff. It may be confirmed by noting that contraction of the quadriceps pulls the tibia anteriorly. The external rotation tests are performed with the patient prone and the knee flexed 30° and 70°. Equal external rotational torque is applied to both feet and the degree of external rotation is recorded. The pivot shift and reverse pivot shift are performed with the patient supine, with the hip in 10-20 degrees of abduction and the tibia in neutral rotation using either the Losee, Noyes, or Jakob techniques. The greatest subluxation, compared to the normal knee, should be recorded.

4. Compartment Findings

   Patellofemoral crepitation is elicited by extension against slight resistance. Medial and lateral compartment crepitation is elicited by extending the knee from a flexed position with a varus stress and then a valgus stress (i.e., McMurray test). Grading is based on intensity and pain.

5. Harvest Site Pathology

   Note tenderness, irritation or numbness at the autograft harvest site.

6. X-ray Findings

   A bilateral, double leg PA weightbearing roentgenogram at 35-45 degrees of flexion (tunnel view) is used to evaluate narrowing of the medial and lateral joint spaces. The Merchant view at 45 degrees is used to document patellofemoral narrowing. A mild grade indicates minimal changes (i.e., small osteophytes, slight sclerosis or flattening of the femoral condyle) and narrowing of the joint space which is just detectable. A moderate grade may have those changes and joint space narrowing (e.g., a joint space of 2-4 mm side or up to 50% joint space narrowing). Severe changes include a joint space of less than 2 mm or greater than 50% joint space narrowing.

7. Functional Test

   The patient is asked to perform a one leg hop for distance on the index and normal side. Three trials for each leg are recorded and averaged. A ratio of the index to normal knee is calculated.

Lysholm Knee Outcome Measure

The Lysholm scale is a well validated functional score designed for knee ligament injuries but has also been validated for other knee injuries. Different scores are more useful at different stages post ligament reconstruction. Functional rating scales may have to be modified for articular cartilage repair. Rating systems for ligament evaluation should look at functional score, activity grading and static stability assessment and functional test before during and after ligament reconstruction.

TOTAL: ____________

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Tegner Activity

Tegner and Lyshom showed that activity grading is a valuable complement to functional scoring of the knee. Limitations in knee function can be masked by a low activity grade. In Tegner's study on 76 patients, the mean score for patients at activity levels 5-10 was 83 +/- 10, and that for patients at activity level 0 was 53 +/- 16 (p < .001). Seventeen percent of patients in activity levels 0-3 had a score above 83.

Terms such as "return to sports" are often used in the evaluation of different treatments of knee ligament injuries. Because different sports and activities put different strains on the knee, such terms lack meaning. It is better to grade different activities on a Tegner and Lysholm activity scale. The preinjury, present, and desired activity levels are readily defined with such a scale.

Level 10	Competitive sports- soccer, football, rugby (national elite)
Level 9	Competitive sports- soccer, football, rugby (lower divisions), ice hockey, wrestling, gymnastics, basketball
Level 8	Competitive sports- racquetball or bandy, squash or badminton, track and field athletics (jumping, etc.), down-hill skiing
Level 7	Competitive sports- tennis, running, motorcars speedway, handball Recreational sports- soccer, football, rugby, bandy, ice hockey, basketball, squash, racquetball, running
Level 6	Recreational sports- tennis and badminton, handball, racquetball, down-hill skiing, jogging at least 5 times per week
Level 5	Work- heavy labor (construction, etc.) Competitive sports- cycling, cross-country skiing, Recreational sports- jogging on uneven ground at least twice weekly
Level 4	Work- moderately heavy labor (e.g. truck driving, etc.)
Level 3	Work- light labor (nursing, etc.)
Level 2	Work- light labor Walking on uneven ground possible, but impossible to back pack or hike
Level 1	Work- sedentary (secretarial, etc.)
Level 0	Sick leave or disability pension because of knee problems