CRITICAL ANALYSIS OF KNEE LIGAMENT RATING SYSTEMS

Sixty-five patients who consecutively underwent anterior cruciate liga ment reconstruction were studied using four individual, categoric, kne e score rating systems. Different results were noted at followup (mean , 35 months; range, 24 to 58) depending on the rating method used. All patients were graded using the Hospital for Special Surgery, Lysholm, Tegner activity, and Cincinnati Knee Ligament rating systems. The Cin cinnati Knee Ligament rating individual scores were noted to be lower than the Hospital for Special Surgery and Lysholm scores for subjectiv e and objective outcome assessment. The Hospital for Special Surgery a nd Lysholm scores did not correlate highly with the Cincinnati Knee Li gament rating final rating, but they did correlate with each other. Th e use of ligament rating scores tended to inflate results, particularl y when raw scores were converted to overall categoric ratings (e.g., e xcellent, good). The Cincinnati Knee Ligament rating system correlates more highly with individual grading and most precisely defines outcom e in athletically active patients. Sources of error may be introduced by a disproportionate combination of unrelated scores or by overrating low-activity-level individuals who avoid stressing their knees. Avoid ance of data generalization remains the optimal method for studying an terior cruciate ligament surgery outcome.