The International Knee Documentation

Committee Subjective Knee Evaluation Form

Normative Data
Allen F. Anderson,*† MD, James J. Irrgang,‡ PhD, PT, ATC, Mininder S. Kocher,§ MD, MPH,
ll ¶
Barton J. Mann, PhD, John J. Harrast, MA, and Members of the International Knee
Documentation Committee
† ‡
From the Tennessee Orthopaedic Alliance, Nashville, Tennessee, the University of Pittsburgh
§
School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, Children’s Hospital,
ll
Boston and Harvard Medical School, Boston, Massachusetts, the American Orthopaedic Society
¶
for Sports Medicine, Rosemont, Illinois, and Data Harbor Incorporated, Chicago, Illinois

Background: The International Knee Documentation Committee Subjective Knee Evaluation Form may be used to measure
symptoms, function, and sports activity for people with a variety of knee disorders, including ligamentous and meniscal injuries,
osteoarthritis, and patellofemoral dysfunction. To date, normative data have not been established for this valid, reliable, and
responsive outcomes instrument.
Purpose: To provide clinicians and researchers with normative data to facilitate the interpretation of results on the International
Knee Documentation Committee Subjective Knee Evaluation Form.
Study Design: Cross-sectional survey.
Methods: The Subjective Knee Evaluation Form was mailed to 600 people in each of 8 age/gender categories (18-24 years, 25-
34 years, 35-50 years, and 51-65 years for both male subjects and female subjects). Participants were drawn from a panel of
550 000 households (1 300 000 subjects) representative of noninstitutionalized persons in the United States and were matched
to data from the United States Census Bureau on geographical region, market size, income, and household size.
Results: Complete data were available for 5246 knees. Twenty-eight percent of respondents reported an injury, weakness, or
other problem with one or both knees. Normative data were determined for respondents as a whole and for the subset of
respondents with no history of knee problems. Mean scores were determined for men aged 18 to 24 years (89 ± 18), 25 to 34
years (89 ± 16), 35 to 50 years (85 ± 19), and 51 to 55 years (77 ± 23); mean scores were also determined for women aged 18
to 24 years (86 ± 19), 25 to 34 years (86 ± 19), 35 to 50 years (80 ± 23), and 51 to 65 years (71 ± 26). Scores were higher for the
subset of respondents with no history of current or prior knee problems.
Conclusion: Scores on the International Knee Documentation Committee Subjective Knee Evaluation Form vary by age, gen-
der, and history of knee problems. The normative data collected in this article will allow clinicians to interpret how patients with
knee injuries are functioning relative to their age- and gender-matched peers and will enable researchers to determine the clin-
ical outcomes of treatment.
Keywords: International Knee Documentation Committee (IKDC); normative data; knee outcomes instrument

*Address correspondence to Allen F. Anderson, MD, Tennessee
Orthopaedic Alliance, 4230 Harding Road, 10th Floor, Nashville, TN
37205 (e-mail: andersonaf@tnortho.com).
One or more authors has declared a potential conflict of interest: James
Irrgang received funding from the AOSSM to perform psychometric analy-
sis of the IKDC form as reported in a manuscript previously published in
the AJSM (29: 600-613, 2001).
The American Journal of Sports Medicine, Vol. 34, No. 1
DOI: 10.1177/0363546505280214
© 2006 American Orthopaedic Society for Sports Medicine
Clinicians and researchers have used numerous knee outcomes
scales to evaluate the results of treatment.4,6-9,13-16,18-21,25-27
Unfortunately, the differences in these scales are suffi-
ciently great to preclude predicting results from one scale
based on another, and the inconsistency among the scales
creates an impediment to progress in the field.1,3,7,15,17,23,24
The International Knee Documentation Committee
(IKDC) was therefore established to unify the assessment
of outcomes by developing a standardized international

128
Vol. 34, No. 1, 2006 IKDC Subjective Knee Evaluation Form 129

knee form. The original IKDC form, published in 1993 and TABLE 1
revised in 1994, included only the minimum essential Number of Respondents by Age and Gender
criteria necessary to evaluate results.2 The committee
envisioned a second, more comprehensive form that would Men Women Total
allow for valid scientific analysis of knee function. The Age Group n % n % n %
new IKDC Subjective Knee Evaluation Form (Subjective
Knee Form), published in 2000, was well tested and found 18 to 24 years 265 10 279 10 544 20
to be an instrument that was valid, reliable,10,11 and 25 to 34 years 288 11 344 13 632 24
responsive (Irrgang JJ, Anderson AF, Boland AL, et al, 35 to 50 years 347 13 376 14 723 27
51 to 65 years 385 14 386 15 771 29
unpublished data, 2004) and that could be used to assess
symptoms, function, and sports activity in patients with a
Total 1285 1385 2670 100
variety of knee disorders, including ligamentous and
meniscal injuries, patellofemoral pain, and osteoarthri-
tis.10,11 More recently, it has also been shown to be signif-
icantly associated with patient satisfaction after ACL that you can perform without significant left knee pain?”
reconstruction.12 References to knee injuries in questions 2, 4, and 6 were
The next step in standardization of the IKDC Subjective also removed. For example, in question 2 (“During the past
Knee Form was collection of normative data. The primary 4 weeks, or since your injury, how often have you had
purpose of this study was to provide clinicians and pain?”), the phrase “or since your knee injury” was deleted
researchers with normative data that would place scores, because it was expected that many respondents would not
changes in scores, and scores from male or female patients have suffered a knee injury. In addition, survey partici-
of different ages within the context of normal population pants were asked several questions, not on the form, that
values. Normative comparison facilitates the interpreta- were related to their current experience of knee
tion of results on the IKDC form for patient management injury/weakness/other problems, current treatment for
decisions and for comparison between groups of patients knee problems, and history of knee surgery.
by demonstrating how close patients come to the normal
range of functioning. Sampling Method
In this cross-sectional study, the IKDC Subjective Knee
Form was administered to a random sample in the United The participants were drawn from a panel that was
States to establish population norms. It was hypothesized recruited and maintained by NFO Worldgroup (Toledo,
that there would be no differences in scores between male Ohio), a marketing research firm. NFO Worldgroup’s panel
and female respondents. The score was, however, expected is a sample of 550 000 households (1 300 000 subjects) that
to demonstrate an inverse relationship with age. A sec- is matched to data from the US Census Bureau on geo-
ondary purpose of this study was to provide additional evi- graphical region, market size, age, income, and household
dence for construct validity of the Subjective Knee Form size. The sample for this study was developed as a strati-
score by examining for differences in scores between fied, random sample that was representative of the age,
respondents with and without a history of knee problems. gender, marital status, household income, household size,
It was hypothesized that people experiencing knee prob- and race of the panel as a whole. The goal was to collect
lems would score lower than those without knee problems. data from approximately 300 men and 300 women within
4 general age categories (18-24 years, 25-34 years, 35-50
METHODS years, and 51-65 years). The target sample size was deter-
mined to achieve a 95% confidence interval (95% CI) and a
The IKDC Subjective Knee Form consists of 18 questions ±5% error rate for each of the 8 age/gender categories.
in the domains of symptoms, functioning during activity of Forms were mailed to 4800 people, representing 9600 pos-
daily living and sports, current function of the knee, and sible knee assessments. The number of respondents by
participation in work and sports (see Appendix, available gender and age groups are reported in Table 1. There was
in the online version of this article at www.ajsm.org/cgi/ no incentive for participation, and there was no attempt to
content/34/1/128/DC1). remind or follow up with people who had not returned a
completed form.
Procedure
Data Management and Analysis
Potential participants were mailed a version of the IKDC
form that was modified to assess the function of both the A score on the Subjective Knee Form can be calculated
left and right knees. For example, question 1 on the form when there are responses to at least 90% of the items (ie,
is, “What is the highest level of activity that you can per- when responses have been provided for at least 16 items).
form without significant knee pain?” In the survey, this In the original scoring instructions for the Subjective Knee
question was separated into 2 parts: “What is the highest Form, missing values are replaced by the average score of
level of activity that you can perform without significant the items that have been answered.11 However, this
right knee pain?” and “What is the highest level of activity method could slightly overestimate or underestimate the
130 Anderson et al The American Journal of Sports Medicine

score, depending on the maximum value of the missing TABLE 2

items (2, 5, or 11 points). In the present study, therefore, Respondents Who Reported a History of Knee Problems,
the score was calculated as follows: Nonsurgical Treatments, and Surgeries

(sum of the completed items – n %

no. of completed items)
Current injury, weakness, or other problem
× 100.
Right knee 237 8.9
(maximum possible sum of the Left knee 174 6.5
completed items – no. of completed items) Both knees 345 13.0
Neither knee 1904 71.3
This method of scoring the IKDC Subjective Knee Form is Receiving current treatment(s)
more accurate than the original method. Right knee 70 2.6
Left knee 53 2.0
Both knees 147 5.5
Analysis Neither knee 2393 89.6
History of knee surgery
Descriptive statistics, including means, percentiles, 95% Right knee 104 3.9
CIs, SDs, ranges, and percentages of ceiling and floor Left knee 87 3.3
scores within each age and gender categories were calcu- Both knees 36 1.3
lated. A 2-way analysis of covariance (ANCOVA) with post Neither knee 2435 91.2
hoc testing was used to identify differences in the Most common knee surgeries
Subjective Knee Form score by gender and age categories Nonspecific arthroscopic 46
(18-24 years, 25-34 years, 35-50 years, and 51-65 years). Ligament repair/removal/reconstruction 31
These age categories were chosen to represent populations Knee replacement 20
Most common length of time since surgery
based on expected levels of physical activity, physical abil-
Median and mode = 5 to 10 years ago
ity, and general health. An ANCOVA was also used to
determine if respondents with a current injury, weakness,
or other knee problems, or respondents currently receiving
treatment for knee problems, had lower scores on the
IKDC form than did respondents who did not have knee
Twenty-eight percent of respondents indicated they
problems.
were currently experiencing an injury, weakness, or other
problem with one or both knees. Ten percent indicated
RESULTS they were currently receiving treatment for one or both
knees (eg, seeing a doctor, physical therapist, or other
The IKDC Subjective Knee Forms were returned by 2670 health care provider; taking medications; or performing
participants (response rate, 56%). Of these people, 2625 exercises for a knee problem). Nine percent reported prior
participants (98%) completed at least 90% of the items (the knee surgery. Of these respondents, 89% had surgery more
criterion for scoring the forms) for their right knee, and than 1 year before this study. The most common surgeries
2621 participants (98%) met the scoring criterion for their reported were nonspecified arthroscopic surgery (20% of
left knee. Sufficiently complete data on 5246 knees were all surgeries) and ligament surgery (14% of all surgeries).
therefore available for computation of the Subjective Knee The frequency of knee problems, nonsurgical treatments,
Form score. Fifty-two percent of all respondents were and surgeries are presented in Table 2.
women. The response rates for each age and gender group The mean scores for the IKDC Subjective Knee Form as
were as follows: between 18 and 24 years, 44% for men, well as 95% CIs, SDs, medians, and sample sizes for each
47% for women; between 25 and 34 years, 48% for men, age/gender group are reported for all respondents in Table
57% for women; between 35 and 50 years, 58% for men, 3. The same information, without the respondents who had
63% for women; and between 51 and 65 years, 64% for a current knee problem, current treatment, or history of
men, 64% for women. knee surgery, is provided in Table 4. These tables also pro-
The difference in the overall response rates of 54% for vide scores from the IKDC form at 5-percentile increments
men and 58% for women was statistically significant (Fisher for each age/gender category. Figures 1 and 2 present these
exact test, P < .01). In addition, there were significant dif- data in graphical format.
ferences in response rates by age category. Response rates The mean score on the IKDC Subjective Knee Form for
were significantly higher (Fisher exact test, P < .01) for the entire sample was 82 (SD, 22; range, 2-100). Twenty-
older age groups (the highest response rate of 64% was six percent of respondents scored 100, the highest possible
found in participants aged 51-65 years) versus younger result. Men scored significantly higher than women (84.4
age groups (the lowest response rate of 46% was found in vs 80.1, respectively; P < .0001), even though men were 5
participants aged 18-24 years) in every comparison. months older, on average, than women (39.6 years vs 39.1
The mean age of respondents was 39 years (SD, 14 years, respectively).
years; range, 18-65 years). Fifty-eight percent were cur- As expected, there was a significant negative correlation
rently married, 29% had never been married, 9% were between age and Subjective Knee Form score (r5246 = –0.25,
divorced, 2% were widowed, and 2% were separated. P < .0001), which provides support for the construct valid-
Vol. 34, No. 1, 2006 IKDC Subjective Knee Evaluation Form 131

TABLE 3 TABLE 4
IKDC Subjective Knee Evaluation Form Percentiles IKDC Subjective Knee Evaluation Form Percentiles and
and Descriptive Statistics by Gender and Agea Descriptive Statistics by Sex and Age (Respondents With
Knee Problems, Treatments, and Surgery Excluded)a
Age Group, Men Age Group, Women
Age Group, Men Age Group, Women
18-24 25-34 35-50 51-65 18-24 25-34 35-50 51-65
Percentile y y y y y y y y 18-24 25-34 35-50 51-65 18-24 25-34 35-50 51-65
Percentile y y y y y y y y
100
95 100.0 100
90 100.0 98.2 95
85 98.9 95.4 90 100.0
80 96.6 100.0 95.4 85 100.0 98.9
75 95.4 100.0 98.9 94.0 80 98.7 96.6
70 100.0 95.4 98.9 100.0 97.7 90.8 75 95.4 95.4
65 97.7 93.1 97.7 98.9 95.4 88.5 70 95.4 100.0 95.4
60 100.0 100.0 95.4 90.8 96.6 97.7 93.5 86.2 65 95.4 100.0 100.0 98.9 94.3
55 98.9 98.7 95.4 89.7 95.4 95.4 90.8 82.8 60 100.0 90.8 98.9 98.9 97.9 94.0
50 97.7 96.6 93.1 86.2 95.4 94.3 89.7 79.3 55 98.9 94.8 97.7 98.9 97.7 92.0
45 96.6 94.3 90.8 83.9 93.1 91.7 86.2 76.2 50 100.0 100.0 96.6 93.1 96.6 97.7 95.4 90.8
40 94.9 92.4 88.7 79.3 90.8 89.6 81.6 69.0 45 98.9 98.9 95.4 91.8 96.6 96.6 94.3 88.5
35 92.0 89.7 86.2 74.7 87.4 87.4 78.2 64.4 40 98.8 96.6 95.4 90.8 95.4 95.4 92.0 86.2
30 89.7 87.4 82.8 71.3 82.8 83.1 73.6 57.5 35 97.7 95.4 93.1 88.5 94.9 93.1 90.8 83.9
25 86.6 83.9 78.2 64.4 77.0 78.6 65.5 52.0 30 95.4 94.3 90.8 86.2 93.1 90.8 89.7 81.6
20 81.6 80.5 69.5 55.3 71.3 73.6 59.8 44.8 25 94.3 92.0 90.8 83.9 91.7 88.5 86.2 78.2
15 70.1 73.6 60.9 47.1 65.5 65.5 52.9 36.8 20 92.0 88.5 87.4 79.3 89.7 86.2 81.6 74.7
10 63.0 65.7 52.9 37.9 54.0 57.5 44.8 28.7 15 89.7 86.2 85.1 74.7 83.9 82.8 78.5 69.0
5 48.4 52.5 44.8 32.2 44.8 42.6 32.1 20.7 10 84.7 82.8 81.6 71.3 78.3 77.1 73.6 59.8
5 78.8 74.7 70.1 63.2 70.7 71.3 63.6 46.0
Mean 89.1 88.9 84.9 77.4 85.7 86.0 79.9 70.9
95% CI 87.6- 87.6- 83.5- 75.8- 84.1- 84.5- 78.3- 69.0- Mean 95.5 94.6 93.1 88.4 93.4 92.5 90.7 84.7
90.6 90.3 86.4 79.1 87.3 87.3 81.6 72.7 95% CI 94.7- 93.7- 92.2- 87.2- 92.5- 91.6- 89.6- 83.2-
SD 17.5 16.3 19.3 23.3 19.1 18.5 22.6 26.0 96.3 95.4 94.0 89.6 94.3 93.5 91.8 86.3
Median 97.7 96.5 93.1 86.2 95.4 94.3 89.7 79.3 SD 8.2 9.0 9.9 13.7 9.5 10.9 12.3 16.2
No. of Median 100.0 100.0 96.6 93.1 96.6 97.7 95.4 90.8
knees 521 572 682 752 558 680 737 744 No. of
knees 396 423 471 478 410 500 466 424
a
IKDC, International Knee Documentation Committee; 95% CI,
a
95% confidence interval. IKDC, International Knee Documentation Committee; 95% CI,
95% confidence interval.

ity of the form. One-way ANOVA confirmed that there was

a statistically significant between-groups effect for age
(F4,5241 = 89.26, P < .0001). However, Scheffe post hoc
analyses indicated that age differences did not emerge
until the group of 35- to 50-year-old respondents. The
youngest age groups did not differ from each other, but the
means in each of these groups were statistically higher
than those of the 2 oldest age groups (35-50 years and 51-
65 years). The mean for the age group of 35- to 50-year-old
respondents was significantly higher than that of the 51-
to 65-year-old respondents. This finding held when the
data for men and women were analyzed separately.
As an assessment of the validity of the IKDC Subjective
Knee Form, scores were compared between respondents
who reported problems in their right knee, their left knee,
both knees, or neither knee. Scores were compared sepa-
rately for right and for left knees. Age was used as a cate-
gorical covariate in these analyses because differences in
scores might be an artifact of age. An ANCOVA revealed,
as expected, that patients who reported current problems
in the target knee or both knees had lower scores than did
patients who had no reported current knee problems or
who only reported problems in the opposite knee. Similar
analyses were performed, with current nonsurgical treat-
ments for knee problems and history of knee surgery as
the independent variables. In all comparisons, the scores
on the Subjective Knee Form were significantly lower for
respondents who reported treatment or surgery on the tar-
get knee, compared to those who reported no treatment or
surgery and those with treatment or surgery on the oppo-
site knee only. Means and SDs for each group as well as
details of these analyses can be found in Table 5.
DISCUSSION
The primary purpose of this study was to establish nor-
mative data for the scores on the IKDC Subjective
Knee Form within a representative population-based sam-
ple. The data (Tables 3 and 4, Figures 1 and 2) provide a
valuable point of reference that allows researchers to
determine knee performance at baseline and provides a
standard to evaluate the significance of treatment within
132 Anderson et al The American Journal of Sports Medicine

100%
95%
90%
85% 51-65 year olds
80%
75%
Percentiles for Men

70% 35-50 year olds

65%
60% 25-34 year olds
55%
18-24 year olds
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

IKDC Knee Score

Figure 1. Subjective Knee Evaluation Form score percentiles for men in the United States. IKDC, International Knee
Documentation Committee.

100%
95%
90% 51-65 year olds
85%
80%
35-50 year olds
Percentiles for Women

75%
70% 18-24 year olds
65% 25-34 year olds
60%
55%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

IKDC Knee Score

Figure 2. Subjective Knee Evaluation Form score percentiles for women in the United States. IKDC, International Knee
Documentation Committee.

the clinical context of normal age- and gender-adjusted Table 3, a 40-year-old woman who scores an 82 has a
values. percentile ranking of 40, indicating that her score is
The normative data can be used to convert a patient’s greater than 40% of all women between the ages of 35
Subjective Knee Form score to the percentile for that and 50 years.
patient’s age/gender category if he or she is Alternatively, the normative data can be used to con-
between 18 and 65 years of age. For example, using vert a patient’s score on the Subjective Knee Form to a
Vol. 34, No. 1, 2006 IKDC Subjective Knee Evaluation Form 133

TABLE 5
Right and Left Knee IKDC Scores by Current Knee Problems, Current Treatments, and History of Knee Surgerya

Right Knee Only Left Knee Only Both Knees Neither Knee
Mean SD n Mean SD n Mean SD n Mean SD n

Current Knee Problems

Right knee 56.9 20.7 234 81.6 17.5 171 50.3 20.3 339 90.8 12.8 1872
Left knee 82.2 17.8 232 53.9 21.4 171 50.8 21.6 341 91.0 12.9 1869

ANCOVAs
Right knee F5,2610 = 636.6, P < .0001; B < R < L < N
Left knee F5,2607 = 593.5, P < .0001; B = L < R < N

Receiving Current Treatment

Right knee 41.1 18.3 68 80.6 18.6 49 42.5 18.8 144 85.5 18.1 2358
Left knee 76.0 19.9 67 49.4 21.8 50 42.7 20.3 144 85.9 18.6 2354

ANCOVAs
Right knee F5,2613 = 266.5, P < .0001; R = B < L = N
Left knee F5,2609 = 214.4, P < .0001; B = L < R < N

History of Knee Surgery

Right knee 56.3 23.2 102 78.2 22.1 81 56.6 25.3 35 83.5 20.6 2399
Left knee 73.0 24.1 103 58.3 25.6 82 51.4 26.9 36 84.2 20.4 2393

ANCOVAs
Right knee F5,2611 = 91.7, P < .0001; R = B < L < N
Left knee F5,2608 = 88.1, P < .0001; B = L < R < N
a
IKDC, International Knee Documentation Committee; ANCOVA, analysis of covariance; R, right; L, left; B, both; N, neither.

standard score (z), which relates the patient’s result to the
population mean and standard deviation for the patient’s
age and gender. The standard score for a patient can be
calculated as follows:
patient’s IKDC Subjective Knee Form score –
mean score for age/gender group
z=
standard deviation for age/gender group
For example, the standard score for a 20-year-old man
who scores a 70 on the Subjective Knee Fo]rm would be
ting a more valid comparison among persons or cohorts
who differ in terms of age and gender. In addition to pro-
viding a benchmark, these data may also serve as starting
points for determining sample size requirements in stud-
ies using the IKDC form.
Age and gender are both statistically significant factors
in understanding Subjective Knee Form scores. As expected,
. an age-related decrease in scores was observed. However,
the finding that these differences did not appear until
after the age of 35 years suggests that either the
Subjective Knee Form has limited sensitivity to distin-
guish between people with relatively high levels of func-
tion related to the knee or that there are, in fact, few actual

[ ]
70 – 89.1132
–1.09 . ulation through early adulthood. These data indicate that
17.5
Consequently, his score would be 1.09 SDs below the pop-
ulation mean for men between 18 and 24 years of age. In
another example, a 52-year-old woman who scores an 80
on the Subjective Knee Form has a standard score of .35,
indicating that her result is .35 of an SD above the popu-
lation mean for women aged between 51 and 65 years.
Converting a patient’s result on the IKDC Subjective Knee
Form to a standard score provides a mechanism to “adjust”
the results based on the patient’s age and gender, permit-
differences in function related to the knee within the pop-
studies including patients between 18 and 34 years of age
do not need to adjust Subjective Knee Form scores for age
differences. However, the differences in scores for subjects
in groups younger than 35 years, compared to those in
groups 35 years and older, indicate that studies using the
IKDC Subjective Knee Form should adjust the score for
age in both men and women when evaluating patients
across these age levels.
Surprisingly, women had lower scores at most per-
centiles and lower mean scores than men when comparing
the same age groups (Table 3). This finding, in addition to
the overall difference in mean scores between men and
134 Anderson et al
women and the age-related decrease in scores, indicates
that results from male and female patients should be ref-
erenced to the same gender cohorts in clinical studies
using the IKDC Subjective Knee Form.
A secondary purpose of this study was to provide addi-
tional evidence for construct validity of the Subjective
Knee Form score by examining for differences in the scores
between respondents with and without a history of knee
problems. As expected, respondents who reported current
problems, treatment, or past surgery of one or both knees
had lower scores compared to respondents who had no cur-
rent problems, treatment, or prior surgery. Respondents
with a current unilateral knee problem, current treat-
ment, or history of knee surgery also had lower scores for
the involved knee compared to the noninvolved knee.
These results indicate that the IKDC Subjective Knee
Form is able to differentiate patients with greater knee
symptoms and lower levels of function, which lends fur-
ther support for interpretation of the Subjective Knee
Form score as a measure of symptoms and function during
activities of daily living and sports.
Normative data were provided for both the respondents
as a whole and the subset of respondents who reported no
history of knee problems because the scores were higher
for the subset of respondents with no history of current or
prior knee problems. The reference population for the data
in Table 3 was the US population at large, including
respondents who reported current knee problems, treat-
ment, or a history of knee surgery. The data in Table 4 rep-
resent the US population that does not have a current
knee problem or a history of knee surgery. When using
these normative data, researchers and clinicians should
carefully consider the population to which they would like
to compare their results, and they should specify which
population was used.
Despite a cross-sectional design, the present study has
limitations. The panel methodology used in this study typ-
ically results in a 60% or higher response rate with a single-
wave mailing. The response rate in this study was only
56%. Even so, the sample size met the margin of error set
a priori (95% CI with a ±5% error rate) and ensured
acceptable sample representation within the 8 age/gender
categories. Although not optimal, the low response rate
was probably not a significant weakness because response
bias effects are minimized if the response rate exceeds
50%.5,22 Another limitation of this study was the failure to
establish normative data for the population group younger
than 18 years.
In summary, the IKDC Subjective Knee Form, a well-
standardized outcomes instrument, is a valuable measure
of symptoms, function, and sports activity. The normative
data described in the present study enhance the value of
this form by providing age- and gender-adjusted values so
clinicians and researchers can assess how patients are
functioning at baseline and can determine the outcomes of
treatment more precisely. Consequently, the results of
studies based on scores from the IKDC Subjective Knee
Form are placed in a firmer context, and decisions are
more likely to lead to improved patient care.
The American Journal of Sports Medicine
The IKDC Subjective Knee Evaluation Form, available
in English, French, German, Italian, Japanese, and
Spanish, may be downloaded from the Internet at
http://www.sportsmed.org/research/index.asp.
ACKNOWLEDGMENT
This study would not have been possible without a grant
from the Orthopaedic Research and Education Foundation
and the AOSSM. Members of the IKDC are as follows: A
Anderson, N Amendola, A Boland, J Feagin, J, Fulkerson,
C Harner, S Howell, J Irrgang, M Kocher, J Richmond,
D Shelbourne (from the AOSSM); H Staubli, N Friedrich,
F Hefti, J Hoher, R Jacob, W Mueller, P Neyret (from the
ESSKA); K Chan, M Kurosaka (from the APOSSM).
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