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The American Journal of Sports Medicine 27:402-416 (1999)
© 1999 American Orthopaedic Society for Sports Medicine

Rigorous Statistical Reliability, Validity, and Responsiveness Testing of the Cincinnati Knee Rating System in 350 Subjects with Uninjured, Injured, or Anterior Cruciate Ligament-Reconstructed Knees

Sue D. Barber-Westin*,{dagger}, Frank R. Noyes, MD* and John W. McCloskey, PhD{ddagger}

* Cincinnati Sportsmedicine and Orthopaedic Center and the Deaconess Hospital, Cincinnati
{ddagger} University of Dayton, Dayton, Ohio

{dagger} Address correspondence and reprint requests to Sue Barber-Westin, BS, Deaconess Hospital, 311 Straight Street, Cincinnati, OH 45219

Although many instruments are used to assess outcome after knee ligament reconstruction, their reliability, validity, and responsiveness have not been adequately proven. Our purpose was to assess these statistical measures in a commonly used instrument, the Cincinnati Knee Rating System. Reliability was determined from the responses of 100 subjects who completed the instrument twice, a mean of 7 days apart. Validity and responsiveness were assessed from 250 patients observed for at least 2 years after autogenous ACL reconstruction. Questionnaire items included symptoms, functional limitations with sports and daily activities, patient perception of the knee condition, and sports- and occupational-activity levels. The items demonstrated high test-retest reliability, supporting their use in evaluating groups of patients between two different treatment periods (all intraclass correlation coefficients >0.70). In addition, the questionnaire demonstrated good content validity, construct validity, and item-discriminant validity. For the overall rating score, no "floor effects" (worst score possible) were found before or after surgery. No "ceiling effects" (best score possible) were found before surgery, and, at follow-up, these effects were calculated in only 22 patients (9%). The questions were found to be highly responsive to detecting changes between evaluations. The data demonstrated that this rating system has acceptable reliability, validity, and responsiveness for use in outcome studies after knee ligament reconstruction.




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