Scoring systems for outcome after knee injuries Bernhard Schmidt-Rohlfing a , Roman Pfeifer a , Jason Kaneshige b , Martijn Hofman a , Matthias Knobe a , Richard Sellei a , Hans-Christoph Pape a, * a University of Aachen Medical Center, Department of Orthopaedic and Trauma Surgery, 30 Pauwels Street, 52074 Aachen, Germany b Parkland Health and Hospital System, University of Texas Southwestern Medical Center Department of Orthopaedic Surgery, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States Introduction and recent clinical findings Objective and subjective scoring systems allow quantifiable measures of various physical findings and subjective complaints amongst patients who had an injury. Outcome measures after trauma is of major scientific and socio-economic interest, and offer the opportunity to compare different therapeutic strategies. In general, measures of outcome should be specific, objective, identifiable, reproducible, quantified, and validated. Conventional outcome measurement of knee function includes objectively defined parameters such as range of motion, radiologi- cal findings, and clinical observations, which include degree of laxity. Increasingly important is the patients’ own evaluation of function utilizing questionnaires. 12 These questionnaires are thought to reflect the patients’ knee function in daily situations. Return to sports and vocational pursuits are of additional interest. In recent years, a large amount of work has been performed to elucidate outcomes after ligament injuries of the knee joint and after total hip arthroplasty. There are various disease- or site- specific questionnaires such as the Algofunctional Index for the Knee (Lequesne), the Oxford 12-item Knee Score, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). 1,5,7,10,17,18,23 Several other scoring systems and general health question- naires such as the Nottingham Health Profile (NHP), the 12-item short-form health survey (SF-12), the 36-item short-form health survey (SF-36), and the Sickness Impact Profile (SIP) focus on general outcome. 2,6,12,14,21 For the outcome measurement of the rehabilitation status of poly-traumatized patients, the HASPOC score (Hannover Score for Polytrauma Outcome) has been established and validated. 24 This score considers the subjective outcome, social issues, and objectively defined parameters of all regions of the human body. The score ranges between 8 (best possible result) and 410 points indicating the worst result. To the best of our knowledge, there is no scoring system available for the outcome measurement of injuries around the Injury, Int. J. Care Injured 42 (2011) 271–275 ARTICLE INFO Article history: Received 8 June 2010 Received in revised form 22 November 2010 Accepted 22 November 2010 Keywords: Knee injury Long-term outcome Polytrauma Scoring system Questionnaires ABSTRACT Outcome assessment after knee injuries and periarticular fractures are not well described in the literature. This review focuses on outcome assessment, specifically surveying various scoring systems after knee trauma. Additionally, we include a report on a series of 637 patients with multiple injuries that were re-examined at least 10 years after the inciting incident. The series includes 48 patients with lower extremity injuries isolated to the knees, and for comparison, 107 poly-traumatized patients with femoral diaphyseal fractures and no other lower extremity injuries. The outcomes were assessed utilizing the Lysholm score, the Tegner activity score, the Hannover Score for Polytrauma Outcome (HASPOC), and the 12-item short-form health survey (SF-12). We calculated correlation coefficients to compare the general health questionnaires with the more specific knee scores. For the comparison of knee injured patients with femoral shaft fracture patients, we applied the Wilcoxon test. With respect to the Tegner activity score, we observed deterioration from a mean preoperative score of 5.0, to 2.8 points at follow up. The mean Lysholm score was 81.97, ranging from 15 to 100 points. However, there was no correlation between results obtained from the Lysholm score with the results of the general health questionnaires. Although not statistically significant, the general health questionnaires (HASPOC and SF-12) trended towards a less favourable outcome for polytraumatized patients who sustained a knee injury in comparison to those with a femoral shaft fracture. In conclusion, the outcomes of knee injuries in poly-traumatized patients are rather heterogeneous, but generally are worse than in those with lower extremity injuries that spare the knee joint. Crown Copyright ß 2010 Published by Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +49 241 80 89350; fax: +49 241 80 82415. E-mail address: papehc@aol.com (H.-C. Pape). Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury 0020–1383/$ – see front matter . Crown Copyright ß 2010 Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2010.11.059