International Knee Documentation Comitee

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Date of completion

IKDC SUBJECTIVE KNEE EVALUATION FORM

Patient's name (or ref

Type of surgery:

Surgery date

INSTRUCTIONS: This survey asks for your view about your knee. This information will help us keep track of how you feel about your knee and how well you are able to do your usual activities.

Answer every question by ticking the appropriate box.

If you are unsure about how to answer a question,

please give the best answer you can.


Symptoms - These questions should be answered thinking of your knee symptoms during the last week.
1. What is the highest level of activity that you can perform without significant knee pain?
	Very strenuous activities like jumping or pivoting as in basketball or soccer
	Strenuous activities like heavy physical work, skiing or tennis
	Moderate activities like moderate physical work, running or jogging
	Light activities like walking, housework or yard work
	Unable to perform any of the above activities due to knee pain

2. During the past 4 weeks, or since your injury, how often have you had pain?
Never	0	1	2	3	4	5	6	7	8	9	10	Constant

3. If you have pain, how severe is it?
No Pain	0	1	2	3	4	5	6	7	8	9	10	Worst Pain

4. During the past 4 weeks, or since your injury, how stiff or swollen was your knee?
	Not at all
	Mildly
	Moderately
	Very
	Extremely

5. What is the highest level of activity you can perform without significant swelling in your knee?
	Very strenuous activities like jumping or pivoting as in basketball or soccer
	Strenuous activities like heavy physical work, skiing or tennis
	Moderate activities like moderate physical work, running or jogging
	Light activities like walking, housework, or yard work
	Unable to perform any of the above activities due to knee swelling

6. During the past 4 weeks, or since your injury, did your knee lock or catch?
	Yes
	No

7. What is the highest level of activity you can perform without significant giving way in your knee?
	Very strenuous activities like jumping or pivoting as in basketball or soccer
	Strenuous activities like heavy physical work, skiing or tennis
	Moderate activities like moderate physical work, running or jogging
	Light activities like walking, housework or yard work
	Unable to perform any of the above activities due to giving way of the knee

Sports activities

8. What is the highest level of activity you can participate in on a regular basis?
	Very strenuous activities like jumping or pivoting as in basketball or soccer
	Strenuous activities like heavy physical work, skiing or tennis
	Moderate activities like moderate physical work, running or jogging
	Light activities like walking, housework or yard work
	Unable to perform any of the above activities due to giving way of the knee

9. How does your knee affect your ability to:
	No difficulty	Minimal difficulty	Moderate difficulty	Extreme difficulty	Unable to do
a. Go up stairs
b. Go down stairs
c. Kneel on the front of your knee
d. Squat
e. Sit with your knee bent
f. Rise from a chair
g. Run straight ahead
h. Jump and land on your involved leg
i. Stop and start quickly

Function, and activity of daily living - The following questions concern your physical function when being active on a higher level. The questions should be answered thinking of what degree of difficulty you have experienced during the last week due to your knee.

10. How would you rate the function of your knee on a scale of 0 to 10 with 10 being normal, excellent function and 0 being the inability to perform any of your usual daily activities which may include sports?

Thank you very much for completing all the questions in this questionnaire.


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IKDC Score is

A group of knee surgeons from Europe and America met in 1987 and founded the International Knee Documentation Committee. A common terminology and an evaluation form were created. This form is the standard form for use in all publications on results of treatment of knee ligament injuries.

IKDC COMMITTEE:

AOSSM: Anderson, A., Bergfeld, J., Boland, A. Dye, S., Feagin, J., Harner, C. Mohtadi, N. Richmond, J. Shelbourne, D., Terry, G.

ESSKA: Staubli, H., Hefti, F., Hoher, J., Jacob, R., Mueller, W., Neyret, P.

APOSSM: Chan, K., Kurosaka, M.

Reference for Score: IKDC 2000 forms

�2009 Kurer/Gooding/Dazines/Sobhy

Created by Dr. Mohamed Sobhy