Top

Archives of Orthopaedic and Trauma Surgery

Published in:

Open Access 01-04-2018 | Arthroscopy and Sports Medicine

Validation of the German version of the Kujala score in patients with patellofemoral instability: a prospective multi-centre study

Authors: D. Dammerer, M. C. Liebensteiner, U. M. Kujala, K. Emmanuel, S. Kopf, F. Dirisamer, J. M. Giesinger

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2018

Abstract

Introduction

The Kujala score is the most frequently used questionnaire for patellofemoral disorders like pain, instability or osteoarthritis. Unfortunately, we are not aware of a validated German version of the Kujala score. The aim of our study was the translation and linguistic validation of the Kujala score in German-speaking patients with patella instability and the assessment of its measurement characteristics.

Materials and methods

The German Kujala score was developed in several steps of translation. In addition to healthy controls, the Kujala German was assessed in consecutive patients undergoing reconstruction of the medial patellofemoral ligament for recurrent patellar dislocations. Pre-op, 6 and 12 months postop the patients completed the Kujala German score, the KOOS, the Lysholm score, a VAS Pain, and the SF-12v2 scores. In addition, there was a Kujala German Score retest preop after a 1-week interval.

Results

We found high reliability in terms of internal consistency for the Kujala score (Cronbach’s alpha = 0.87). Convergent validity with the KOOS (symptom r = 0.65, pain r = 0.78, ADL r = 0.74, sports/recreation r = 0.84, quality of life r = 0.70), the Lysholm score (r = 0.88) and the SF-12 physical component summary score (r = 0.79) and VAS pain (r = − 0.71) was also very high. Discriminant validity in terms of correlation with the SF-12 mental component summary Score was satisfactory (r = 0.14).

Conclusions

In conclusion, the German version of the Kujala score proved to be a reliable and valid instrument in the setting of a typical patellofemoral disease treated with a standard patellofemoral procedure.

Schottle PB, Hensler D, Imhoff AB (2010) Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc 18:147–151. https://doi.org/10.1007/s00167-009-0868-z CrossRefPubMed

Siebold R, Chikale S, Sartory N, Hariri N, Feil S, Passler HH (2010) Hamstring graft fixation in MPFL reconstruction at the patella using a transosseous suture technique. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-010-1147-8

Blond L, Schottle PB (2010) The arthroscopic deepening trochleoplasty. Knee Surg Sports Traumatol Arthrosc 18:480–485. https://doi.org/10.1007/s00167-009-0935-5 CrossRefPubMed

Brown GD, Ahmad CS (2008) Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in skeletally immature patients. J Knee Surg 21:328–332CrossRefPubMed

Gigante A, Enea D, Greco F, Bait C, Denti M, Schonhuber H, Volpi P (2009) Distal realignment and patellar autologous chondrocyte implantation: mid-term results in a selected population. Knee Surg Sports Traumatol Arthrosc 17:2–10. https://doi.org/10.1007/s00167-008-0635-6 CrossRefPubMed

Watson CJ, Propps M, Ratner J, Zeigler DL, Horton P, Smith SS (2005) Reliability and responsiveness of the lower extremity functional scale and the anterior knee pain scale in patients with anterior knee pain. J Orthop Sports Phys Ther 35:136–146CrossRefPubMed

Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163CrossRefPubMed

Crossley KM, Bennell KL, Cowan SM, Green S (2004) Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Arch Phys Med Rehabil 85:815–822CrossRefPubMed

Banke IJ, Kohn LM, Meidinger G, Otto A, Hensler D, Beitzel K, Imhoff AB, Schottle PB (2014) Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc 22:2591–2598. https://doi.org/10.1007/s00167-013-2603-z CrossRefPubMed

10.

Blond L, Haugegaard M (2014) Combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament for patients with recurrent patella dislocation and trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 22:2484–2490. https://doi.org/10.1007/s00167-013-2422-2 CrossRefPubMed

11.

Dejour D, Byn P, Ntagiopoulos PG (2013) The Lyon’s sulcus-deepening trochleoplasty in previous unsuccessful patellofemoral surgery. Int Ortho 37:433–439. https://doi.org/10.1007/s00264-012-1746-8 CrossRef

12.

Donell ST, Joseph G, Hing CB, Marshall TJ (2006) Modified dejour trochleoplasty for severe dysplasia: operative technique and early clinical results. Knee 13:266–273. https://doi.org/10.1016/j.knee.2006.01.004 pii]CrossRefPubMed

13.

Faruqui S, Bollier M, Wolf B, Amendola N (2012) Outcomes after trochleoplasty. The Iowa orthopaedic journal 32:196–206PubMedPubMedCentral

14.

Fucentese SF, Schottle PB, Pfirrmann CW, Romero J (2007) CT changes after trochleoplasty for symptomatic trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 15:168–174. https://doi.org/10.1007/s00167-006-0140-8 CrossRefPubMed

15.

Fucentese SF, Zingg PO, Schmitt J, Pfirrmann CW, Meyer DC, Koch PP (2011) Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty. Knee Surg Sports Traumatol Arthrosc 19:1655–1661. https://doi.org/10.1007/s00167-011-1410-7 CrossRefPubMed

16.

Goutallier D, Raou D, Van Driessche S (2002) Retro-trochlear wedge reduction trochleoplasty for the treatment of painful patella syndrome with protruding trochleae. Technical note and early results. Rev Chir Orthop Reparatrice Appareil Moteur 88:678–685

17.

Nelitz M, Dreyhaupt J, Lippacher S (2013) Combined trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocations in severe trochlear dysplasia: a minimum 2-year follow-up study. Am J sports Med 41:1005–1012. https://doi.org/10.1177/0363546513478579 CrossRefPubMed

18.

Neumann MV, Stalder M, Schuster AJ (2014) Reconstructive surgery for patellofemoral joint incongruency. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-014-3397-3 PubMed

19.

Ntagiopoulos PG, Byn P, Dejour D (2013) Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J sports Med 41:998–1004. https://doi.org/10.1177/0363546513482302 CrossRefPubMed

20.

Rouanet T, Gougeon F, Fayard JM, Remy F, Migaud H, Pasquier G (2015) Sulcus deepening trochleoplasty for patellofemoral instability: A series of 34 cases after 15 years postoperative follow-up. Orthop Traumatol Surg Res OTSR 101:443–447. https://doi.org/10.1016/j.otsr.2015.01.017 CrossRefPubMed

21.

Schottle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: A minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76:693–698. https://doi.org/10.1080/17453670510041781 CrossRefPubMed

22.

Schottle PB, Schell H, Duda G, Weiler A (2007) Cartilage viability after trochleoplasty. Knee Surg Sports Traumatol Arthrosc 15:161–167. https://doi.org/10.1007/s00167-006-0148-0 CrossRefPubMed

23.

Thaunat M, Bessiere C, Pujol N, Boisrenoult P, Beaufils P (2011) Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol OTSR 97:833–845. https://doi.org/10.1016/j.otsr.2011.07.013 PubMed

24.

Utting MR, Mulford JS, Eldridge JD (2008) A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Jt Surg Br Vol 90:180–185. https://doi.org/10.1302/0301-620x.90b2.20017 CrossRef

25.

Verdonk R, Jansegers E, Stuyts B (2005) Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc 13:529–533. https://doi.org/10.1007/s00167-004-0570-0 CrossRefPubMed

26.

von Knoch F, Bohm T, Burgi ML, von Knoch M, Bereiter H (2006) Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Jt Surg Br 88:1331–1335. https://doi.org/10.1302/0301-620X.88B10.17834 CrossRef

27.

Kuru T, Dereli EE, Yaliman A (2010) Validity of the Turkish version of the Kujala patellofemoral score in patellofemoral pain syndrome. Acta Orthop Traumatol Turc 44:152–156. https://doi.org/10.3944/AOTT.2010.2252 CrossRefPubMed

28.

Gil-Gamez J, Pecos-Martin D, Kujala UM, Martinez-Merinero P, Montanez-Aguilera FJ, Romero-Franco N, Gallego-Izquierdo T (2016) Validation and cultural adaptation of “Kujala Score” in Spanish. Knee Surg Sports Traumatol Arthrosc 24:2845–2853. https://doi.org/10.1007/s00167-015-3521-z CrossRefPubMed

29.

Kievit AJ, Breugem SJ, Sierevelt IN, Heesterbeek PJ, van de Groes SA, Kremers KC, Koeter S, Haverkamp D (2013) Dutch translation of the Kujala anterior knee pain scale and validation in patients after knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2647–2653. https://doi.org/10.1007/s00167-013-2635-4 CrossRefPubMed

30.

Papadopoulos C, Constantinou A, Cheimonidou AZ, Stasinopoulos D (2017) Greek cultural adaption and validation of the Kujala anterior knee pain scale in patients with patellofemoral pain syndrome. Disabil Rehabil 39:704–708. https://doi.org/10.3109/09638288.2016.1161834 CrossRefPubMed

31.

Cheung RT, Ngai SP, Lam PL, Chiu JK, Fung EY (2012) Chinese translation and validation of the Kujala scale for patients with patellofemoral pain. Disabil Rehabil 34:510–513. https://doi.org/10.3109/09638288.2011.610494 CrossRefPubMed

32.

Apivatgaroon A, Angthong C, Sanguanjit P, Chernchujit B (2016) The validity and reliability of the Thai version of the Kujala score for patients with patellofemoral pain syndrome. Disabil Rehabil 38:2161–2164. https://doi.org/10.3109/09638288.2015.1114035 CrossRefPubMed

33.

Liebensteiner MC, Szubski C, Raschner C, Krismer M, Burtscher M, Platzer HP, Deibl M, Dirnberger E (2008) Frontal plane leg alignment and muscular activity during maximum eccentric contractions in individuals with and without patellofemoral pain syndrome. Knee 15:180–186. https://doi.org/10.1016/j.knee.2008.01.009 CrossRefPubMed

34.

Ostermeier S, Stukenborg-Colsman C, Wirth CJ, Bohnsack M (2007) Reconstruction of the medial patellofemoral ligament by tunnel transfer of the semitendinosus tendon. Oper Orthop Traumatol 19:489–501. https://doi.org/10.1007/s00064-007-1022-0 CrossRefPubMed

35.

Bily W, Trimmel L, Modlin M, Kaider A, Kern H (2008) Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study. Arch Phys Med Rehabil 89:1230–1236. https://doi.org/10.1016/j.apmr.2007.10.048 pii]CrossRefPubMed

36.

Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P (2005) Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ispor task force for translation and cultural adaptation. Value Health 8:94–104. https://doi.org/10.1111/j.1524-4733.2005.04054.x CrossRefPubMed

37.

Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC (2010) The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 63:737–745. https://doi.org/10.1016/j.jclinepi.2010.02.006 CrossRefPubMed

38.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96CrossRefPubMed

39.

Wright RW (2009) Knee injury outcomes measures. J Am Acad Orthop Surg 17:31–39CrossRefPubMed

40.

Kessler S, Lang S, Puhl W, Stove J (2003) The knee injury and osteoarthritis outcome score–a multifunctional questionnaire to measure outcome in knee arthroplasty. Z Orthop Ihre Grenzgeb 141:277–282. https://doi.org/10.1055/s-2003-40083 CrossRefPubMed

41.

Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154CrossRefPubMed

42.

Wirth B, Liffert F, de Bruin ED (2011) Development and evaluation of a German version of the Lysholm score for measuring outcome after anterior cruciate ligament injuries. Sportverletz Sportschaden Organ Ges Orthop Traumatol Sportmed 25:37–43. https://doi.org/10.1055/s-0029-1245825

43.

Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233CrossRefPubMed

44.

Juniper EF, Guyatt GH, Jaeschke R (1996) How to develop and validate a new health-related instrument. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials. Lippincott-Raven Publishers, Philadelphia, pp 49–56

45.

Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42. https://doi.org/10.1016/j.jclinepi.2006.03.012 CrossRefPubMed

46.

Ringash J, O’Sullivan B, Bezjak A, Redelmeier DA (2007) Interpreting clinically significant changes in patient-reported outcomes. Cancer 110:196–202. https://doi.org/10.1002/cncr.22799 CrossRefPubMed

47.

Nunnally JC, Bernstein IH (1994) Psychometric theory. McGraw-Hill, New York

48.

Singhal R, Rogers S, Charalambous CP (2013) Double-bundle medial patellofemoral ligament reconstruction with hamstring tendon autograft and mediolateral patellar tunnel fixation: a meta-analysis of outcomes and complications. Bone Jt J 95-B:900–905. https://doi.org/10.1302/0301-620X.95B7.31417 CrossRef

49.

Negahban H, Pouretezad M, Yazdi MJ, Sohani SM, Mazaheri M, Salavati M, Aryan N, Salehi R (2012) Persian translation and validation of the Kujala patellofemoral scale in patients with patellofemoral pain syndrome. Disabil Rehabil 34:2259–2263. https://doi.org/10.3109/09638288.2012.683480 CrossRefPubMed

50.

da Cunha RA, Costa LO, Hespanhol Junior LC, Pires RS, Kujala UM, Lopes AD (2013) Translation, cross-cultural adaptation, and clinimetric testing of instruments used to assess patients with patellofemoral pain syndrome in the Brazilian population. J Orthop Sports Phys Ther 43:332–339. https://doi.org/10.2519/jospt.2013.4228 CrossRefPubMed

Title: Validation of the German version of the Kujala score in patients with patellofemoral instability: a prospective multi-centre study
Authors: D. Dammerer
M. C. Liebensteiner
U. M. Kujala
K. Emmanuel
S. Kopf
F. Dirisamer
J. M. Giesinger
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 4/2018
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-2881-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Validation of the German version of the Kujala score in patients with patellofemoral instability: a prospective multi-centre study

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2018

Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study

The relationship between the degree of displacement of the atlas to axis and the clinical data in atlanto-axial subluxation due to rheumatoid arthritis

Evaluation of accuracy of virtual surgical planning for patient-specific pre-contoured plate in acetabular fracture fixation

Hip malformation is a very common finding in young patients scheduled for total hip arthroplasty

Repeated closed reduction attempts of distal radius fractures in the emergency department

Total knee arthroplasty with unexplained pain: new insights from kinematics