Date of Completion

IDKC Score
IKDC SUBJECTIVE KNEE EVALUATION FORM
Patient's name (or ref
Clinician Diagnosis
Type of surgery:
Patient's d.o.b
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:
a. Go up stairs
No difficulty
Minimal difficulty
Moderate difficulty
Extreme difficulty
Unable to do
b. Go down stairs
No difficulty
Minimal difficulty
Moderate difficulty
Extreme difficulty
Unable to do
c. Kneel on the front of your knee
No difficulty
Minimal difficulty
Moderate difficulty
Extreme difficulty
Unable to do
d. Squat
No difficulty
Minimal difficulty
Moderate difficulty
Extreme difficulty
Unable to do
e. Sit with your knee bent
No difficulty
Minimal difficulty
Moderate difficulty
Extreme difficulty
Unable to do
f. Rise from a chair
No difficulty
Minimal difficulty
Moderate difficulty
Extreme difficulty
Unable to do
g. Run straight ahead
No difficulty
Minimal difficulty
Moderate difficulty
Extreme difficulty
Unable to do
h. Jump and land on your involved leg
No difficulty
Minimal difficulty
Moderate difficulty
Extreme difficulty
Unable to do
i. Stop and start quickly
No difficulty
Minimal difficulty
Moderate difficulty
Extreme difficulty
Unable to do

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?
Function prior to knee injury
  • Can not perform ADL 0 1 2 3 4 5 6 7 8 9 10 No limitation of ADL
Current function of your knee:
  • Can not perform ADL 0 1 2 3 4 5 6 7 8 9 10 No limitation of ADL

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

IKDC Score is %

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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.

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Fritz JM, George S. Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs. Phys Ther. 2002; 82(10): 973-983.

Lethem J, Slade PD, Troup JDG, Bendey G. Outline of a fear avoidance model of exaggerated pain perceptions, Behav Res Ther. 1983;21:401-408.

Williamson E. Fear Avoidance Behavior Questionnaire. Austrailian Journal of Physiotherapy. 2006; 52: 149.

Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eck H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62: 36, 272.