Patient-reported outcome scores following patellar instability surgery-high prevalence does not equal high responsiveness: a systematic review

Justin A. Magnuson, Brooks N. Platt, Anthony J. Zacharias, Lucy C. Bowers, Cale A. Jacobs, Joseph N. Liu, Austin V. Stone

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


Purpose: The purpose of this study was to determine the utilization and responsiveness of common patient-reported outcomes (PROs) in patients undergoing surgery for patellar instability. Methods: Using PRISMA guidelines, a systematic review of studies reporting outcomes following surgical intervention for patellar instability was conducted using Pubmed, Cochrane, OVID Medline, and Google Scholar. Subgroup analysis of articles reporting at least two PROs with baseline and follow-up data were used to evaluate responsiveness of instruments using relative efficiency and effect size. Results: From the search, 2,848 unique articles were found, of which 178 were included in final analysis (7,122 patients, mean age 22.6, 63.6% female). The most commonly used PRO was the Kujala score (79.2%), followed by the Lysholm (34.8%), and Tegner (30.9%). Seventy-nine articles were eligible for subgroup analysis. The Kujala had a higher relative efficiency than ten of the 14 instruments to which it was compared but had lower relative efficiency compared to the IKDC and Lysholm scores. The Banff Patella Instability Instrument (BPII) and the Norwich score, condition-specific tools, were unable to be fully assessed due to rarity of use and lack of comparisons. Conclusion: The hypothesis that the Kujala score is the most commonly used PRO for patellar instability, although other instruments offer greater efficiency was supported by our results. The IKDC and Lysholm scores had similar effect sizes but higher relative efficiencies than the Kujala, thus suggesting better responsiveness. This analysis adds useful information for surgeons on the effectiveness of the most common PRO’s for evaluating patellofemoral instability outcomes. Level of evidence: Level III.

Original languageEnglish
Pages (from-to)1453-1460
Number of pages8
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number4
StatePublished - Apr 2022

Bibliographical note

Publisher Copyright:
© 2021, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).


  • Knee
  • Medial patellofemoral ligament reconstruction
  • Patellar instability
  • Patient-reported outcomes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Patient-reported outcome scores following patellar instability surgery-high prevalence does not equal high responsiveness: a systematic review'. Together they form a unique fingerprint.

Cite this