IKDC Subjective Knee Evaluation

1. What is the highest level of activity that you can perform without significant knee pain?

Unable to perform any activities due to knee pain Light activities like walking, housework, or yard work Moderate activities like moderate physical work, running or jogging Strenuous activities like heavy physical work, skiing or tennis Very strenuous activities like jumping or pivoting as in basketball or soccer

2. During the past 4 weeks, or since injury, how often have you had pain?

5

3. If you have pain, how severe is it?

5

4. During the past 4 weeks, or since your injury, how stiff or swollen was your knee??

None at all Mildly Moderately Very Extremely

5. What is the highest level of activity you can perform without significant swelling in your knee?

Unable to perform any activities due to knee swelling Light activities like walking, housework, or yard work Moderate activities like moderate physical work, running or jogging Strenuous activities like heavy physical work, skiing or tennis Very strenuous activities like jumping or pivoting as in basketball or soccer

6. During the past 4 weeks, or since your injury, did your knee lock or catch?

Yes No

7. What is the highest level of activity you can perform without significant giving way in your knee?

Unable to perform any activities due to knee giving way of the knee Light activities like walking, housework, or yard work Moderate activities like moderate physical work, running or jogging Strenuous activities like heavy physical work, skiing or tennis Very strenuous activities like jumping or pivoting as in basketball or soccer

8. What is the highest level of activity you can participate in on a regular basis?

Unable to perform any activities due to knee Light activities like walking, housework, or yard work Moderate activities like moderate physical work, running or jogging Strenuous activities like heavy physical work, skiing or tennis Very strenuous activities like jumping or pivoting as in basketball or soccer

9. How does your knee affect your ability to:

a. Go up stairs

Unable to do Extremely difficult Moderately difficult Minimally difficult Not difficult at all

b. Go down stairs

Unable to do Extremely difficult Moderately difficult Minimally difficult Not difficult at all

c. Kneel on the front of your knee

Unable to do Extremely difficult Moderately difficult Minimally difficult Not difficult at all

d. Squat

Unable to do Extremely difficult Moderately difficult Minimally difficult Not difficult at all

e. Sit with your knee bent

Unable to do Extremely difficult Moderately difficult Minimally difficult Not difficult at all

f. Rise from a chair

Unable to do Extremely difficult Moderately difficult Minimally difficult Not difficult at all

g. Run straight ahead

Unable to do Extremely difficult Moderately difficult Minimally difficult Not difficult at all

h. Jump and land on your involved leg

Unable to do Extremely difficult Moderately difficult Minimally difficult Not difficult at all

i. Stop and start quickly

Unable to do Extremely difficult Moderately difficult Minimally difficult Not difficult at all

10. How would you rate the function of your knee on a scale of 0 to 10?

FUNTION PRIOR TO YOUR KNEE INJURY:

5

CURRENT FUNCTION OF YOUR KNEE:

5