title: Determining utility values in patients with anterior cruciate ligament tears using clinical scoring systems.
abstract: BACKGROUND
  Several instruments and clinical scoring systems have been established to evaluate patients with ligamentous knee injuries. A comparison of individual articles in the literature is challenging, not only because of heterogeneity in methodology, but also due to the variety of the scoring systems used to document clinical outcomes. There is limited information about the correlation between used scores and quality of life with no information being available on the impact of each score on the utility values. The aim of this study was to compare the most commonly used scores for evaluating patients with anterior cruciate ligament (ACL) injuries, and to establish corresponding utility values. These values will be used for the interpretation and comparison of outcome results in the currently available literature for different treatment options.
  
  
  METHODS
  Four hypothetical vignettes were defined, based on different levels of activities after rupture of the ACL to simulate typical situations seen in daily practice. A questionnaire, including the Health Utility Index (HUI) for utility values, the IKDC subjective score, the Lysholm and the Tegner score, was created and 25 orthopedic surgeons were asked to fill the questionnaire for each hypothetical patient as proxies for all patients they had treated and who would fit in that hypothetical vignette.
  
  
  RESULTS
  The utility value as an indicator for quality of life increased with the level of activity. Having discomforts already during normal activities of daily living was rated with a mean utility value of 0.37 ± 0.19, half of that of a situation where mild sport activity was possible without discomfort (0.78 ± 0.11). All investigated scores were able to distinguish clearly (p < 0.05) between the hypothetical vignettes. However, the utility values correlated best with the IKDC subjective score (r = 0.86, p < 0.001) followed by the Lysholm score (r = 0.77, p < 0.001) and the Tegner score (r = 0.77, p < 0.001).
  
  
  CONCLUSIONS
  Here we report the correlation between the most commonly used scores for the assessment of patients with a ruptured ACL and utility values as an indicator of quality of life. Assumptions were based on expert opinions to provide a possible transformation algorithm. The IKDC subjective knee score showed the highest correlation to the quality of life (i.e. HUI) in patients with a ruptured ACL. Confirmation of our results is needed by systematic inclusion of a measurement instrument for utility values in future clinical studies beside the already used clinical knee scoring systems.
authors.affiliation: Balgrist University Hospital, Orthopedic Surgery, University of Zürich, Switzerland. Mazda.Farshad@balgrist.ch
authors.forename: Mazda
authors.initials: M
authors.lastname: Farshad
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
authors.forename: Thomas
authors.initials: T
authors.lastname: Szucs
authors.forename: Dominik C
authors.initials: DC
authors.lastname: Meyer
mesh_terms: D000203:Activities of Daily Living; D000739:Anecdotes as Topic; D000070598:Anterior Cruciate Ligament Injuries; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011788:Quality of Life; D020127:Recovery of Function; D012421:Rupture; D011795:Surveys and Questionnaires