Date of completion
Knee Society Score    
Clinician's name (or ref)
Patient's name (or ref)
Patient's d.o.b
 
During the past 4 weeks......
Part 1 - Knee Score
Pain   Flexion Contracture (if present)
None   5°-10°
Mild / Occasional   10°-15°
Mild (Stairs only)   16°-20°
Mild (Walking and Stairs   >20°
Moderate - Occasional   Extension lag
Moderate - Continual   <10°
Severe   10-20°
      >20°
     
Total Range of Flexion   Alignment (Varus & Valgus)
0-5 6-10 11-15 16-20 21-25   0 1 2 3 4
26-30 31-35 36-40 41-45 46-50           5 - 10        
51-55 56-60 61-65 66-70 71-75   11 12 13 14 15
76-80 81-85 86-90 91-95 96-100           Over 15°        
101-105 106-110 111-115 116-120 121-125                      
   
Stability (Maximum movement in any position)
Antero-posterior   Mediolateral
<5mm    <5°
5-10mm    6-9°
10+mm    10-14°
     15°

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Final Knee Score is

(NB: consider a negitive outcome as zero)
 

Grading for the knee Society Score

Score 80-100

Excellent
Score 70-79
 Good
Score 60-69
 Fair
Score below 60
 Poor

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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.