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The reliability and validity of knee-specific and general health instruments in assessing acute patellar dislocation
Elizabeth W Paxton1, Donald C Fithian, Mary Lou Stone
1Department of Orthopedics, Southern California Permanente Medical Group, San Diego, California, USA.
Background:
The most reliable and valid instruments for assessing patient outcome after patellar dislocation have not been identified.
Hypothesis:
Knee-specific and general health instruments will differ in validity and reliability for patients with patellar dislocation.
Study Design:
Prospective cohort study.
Methods:
Subjects consisted of 153 patients with acute patellar dislocation (110 with first-time dislocations and 43 with a history of patellofemoral subluxation or dislocation). We administered the modified International Knee Documentation Committee form, Kujala, Fulkerson, Lysholm, Tegner, Short Form 36, and Musculoskeletal Function Assessment instruments on two separate occasions (test-retest reliability). Validity was assessed by comparing scores of the two groups and by comparing scores of patients with and without recurrent subluxations/dislocations during follow-up.
Results:
The knee-specific instruments yielded the highest test-retest reliability. The knee-specific and general health instruments identified higher disability levels in the patients with a history of patellofemoral problems than in those with first-time dislocations. The general health instruments identified higher disability levels in patients with patellar dislocation than published norms. The Fulkerson and Lysholm scales were the only instruments to differentiate between patients with and without recurrent subluxations/dislocations.
Conclusions:
Knee-specific scales yielded higher reliability coefficients and stronger validity than did general health instruments. Knee-specific, general health, and activity level instruments are complementary and in combination provide a more complete assessment for patients with patellar dislocation.