ID

28923

Beskrivning

Evalution of ACL reconstruction. References: Feagin Jr, J. A., & Blake, W. P. (1983). Postoperative evaluation and result recording in the anterior cruciate ligament reconstructed knee. Clinical Orthopaedics and Related Research®, 172, 143-147. Blake, W. P.: Personal communication, Gainesville Orthopaedic Group, Gainesville, Florida, 1980. Cohen, L. L.: Personal communication, Santa Fe

Nyckelord

Versioner (3)
  1. 2018-02-16 2018-02-16 -
  2. 2018-02-20 2018-02-20 -
  3. 2018-05-09 2018-05-09 - Halim Ugurlu
Rättsinnehavare

Feagin Jr, J. A.; Blake, W. P.

Uppladdad den

16 februari 2018

DOI

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Creative Commons BY-NC 3.0
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Anterior cruciate ligament follow-up form

Engelsk

Anterior cruciate ligament follow-up form

1 Formulär  
Identification
Beskrivning

Identification

Date
Beskrivning

Date

Datatyp

date

Alias
UMLS CUI [1]
C0011008
Last Name
Beskrivning

Last Name

Datatyp

text

Alias
UMLS CUI [1]
C1301584
First Name
Beskrivning

First Name

Datatyp

text

Alias
UMLS CUI [1]
C1443235
Initials
Beskrivning

Patient Initials

Datatyp

text

Alias
UMLS CUI [1]
C2986440
SS #
Beskrivning

Social Security number

Datatyp

integer

OFF #
Beskrivning

OFF number

Datatyp

text

Age
Beskrivning

Age

Datatyp

integer

Måttenheter
  • years
Alias
UMLS CUI [1]
C0001779
years
Sex
Beskrivning

Sex

Datatyp

text

Alias
UMLS CUI [1]
C0079399
Knee involved
Beskrivning

Knee involved

Datatyp

text

Phone #
Beskrivning

Phone number

Datatyp

integer

Name of someone who can reach you if you have moved
Beskrivning

Name of close person

Datatyp

text

Phone # of someone who can reach you if you have moved
Beskrivning

Phone number of close person

Datatyp

integer

Date of surgery
Beskrivning

Date of surgery

Datatyp

date

Number of months since surgery
Beskrivning

Number of months since surgery

Datatyp

integer

Post-OP course
Beskrivning

Post-OP course

Cast?
Beskrivning

Cast

Datatyp

boolean

# weeks in rigid cast
Beskrivning

duration rigid cast

Datatyp

integer

# weeks in flexible/hinged cast
Beskrivning

duration flexible/hinged cast

Datatyp

integer

Brace?
Beskrivning

Brace

Datatyp

boolean

Current brace use?
Beskrivning

Current brace use

Datatyp

text

Physical Therapy?
Beskrivning

Physical Therapy

Datatyp

boolean

# months in supervised program (Cybex Ortholron etc.)
Beskrivning

supervised physical therapy duration

Datatyp

integer

Are you still doing a regular home program?
Beskrivning

physical therapy home program

Datatyp

boolean

Symptoms
Beskrivning

Symptoms

Knee pain?
Beskrivning

Knee pain

Datatyp

integer

Giving way?
Beskrivning

Giving way

Datatyp

integer

Swelling?
Beskrivning

Swelling

Datatyp

integer

Stiffness?
Beskrivning

Stiffness

Datatyp

integer

Symptom Total points
Beskrivning

total points symptoms

Datatyp

integer

Symptom Summary = Total / 4
Beskrivning

Symptom Summary

Datatyp

integer

Function
Beskrivning

Function

Activity level?
Beskrivning

Activity level

Datatyp

integer

Function Summary (Activity level)
Beskrivning

function summary

Datatyp

integer

Problems with specific activities: Walking?
Beskrivning

Walking

Datatyp

text

Problems with specific activities: Running?
Beskrivning

Running

Datatyp

text

Problems with specific activities: Turn/Cut?
Beskrivning

Turn/Cut

Datatyp

text

Problems with specific activities: Jumping?
Beskrivning

Jumping

Datatyp

text

Problems with specific activities: Stairs?
Beskrivning

Stairs

Datatyp

text

If your prior injury activity level rates at 10, what does your current activity level rate?
Beskrivning

rating activity level

Datatyp

integer

If your normal knee performs 100%, at what % does your operated knee perform?
Beskrivning

rating knee performance

Datatyp

integer

Måttenheter
  • %
%
Surgical Hx
Beskrivning

Surgical Hx

Type ACL Injury
Beskrivning

Type ACL Injury

Datatyp

text

Associated injury (acute or chronic)
Beskrivning

Associated injury

Datatyp

text

ACL Surgery
Beskrivning

ACL Surgery

Datatyp

text

Primary Repair Aug with
Beskrivning

ACL Surgery Primary repair

Datatyp

text

Reconstruction with
Beskrivning

ACL Surgery Reconstruction

Datatyp

text

Subsequent Injury
Beskrivning

Subsequent Injury

Datatyp

text

Subsequent Surgery
Beskrivning

Subsequent Surgery

Datatyp

text

Stability
Beskrivning

Stability

Anterior Drawer / Lachman: Right leg, 15°
Beskrivning

record as 0 tr 1+ 2+ 3+

Datatyp

text

Anterior Drawer / Lachman: Right leg, 90°
Beskrivning

record as 0 tr 1+ 2+ 3+

Datatyp

text

Anterior Drawer / Lachman: Left leg, 15°
Beskrivning

record as 0 tr 1+ 2+ 3+

Datatyp

text

Anterior Drawer / Lachman: Left leg, 90°
Beskrivning

record as 0 tr 1+ 2+ 3+

Datatyp

text

Subluxation (Pivot shift, Jerk, etc.): Right leg
Beskrivning

record as 0 tr 1+ 2+ 3+

Datatyp

text

Subluxation (Pivot shift, Jerk, etc.): Left leg
Beskrivning

record as 0 tr 1+ 2+ 3+

Datatyp

text

Varus: Right leg, 0°
Beskrivning

Varus right 0 degrees

Datatyp

text

Varus: Right leg, 30°
Beskrivning

Varus right 30 degrees

Datatyp

text

Varus: Left leg, 0°
Beskrivning

Varus left 0 degrees

Datatyp

text

Varus: Left leg, 30°
Beskrivning

Varus left 30 degrees

Datatyp

text

Valgus: Right leg, 0°
Beskrivning

Valgus right 0 degrees

Datatyp

text

Valgus: Right leg, 30°
Beskrivning

Valgus right 30 degrees

Datatyp

text

Valgus: Left leg, 0°
Beskrivning

Valgus left 0 degrees

Datatyp

text

Valgus: Left leg, 30°
Beskrivning

Valgus left 30 degrees

Datatyp

text

Range of motion: Right leg
Beskrivning

Range of motion right

Datatyp

integer

Måttenheter
  • °
°
Range of motion: Left leg
Beskrivning

Range of motion left

Datatyp

integer

Måttenheter
  • °
°
Additional studies: X-ray
Beskrivning

Additional studies: X-ray

Med joint DJD
Beskrivning

X-ray Med joint DJD

Datatyp

text

Lat joint DJD
Beskrivning

X-ray lat joint DJD

Datatyp

text

P/F joint DJD
Beskrivning

X-ray P/F joint DJD

Datatyp

text

ICN osteophytes
Beskrivning

X-ray ICN osteophytes

Datatyp

text

Other (your favorite test)
Beskrivning

Other X-ray

Datatyp

text

Additional studies: Cybex/Orthotron (if available)
Beskrivning

Additional studies: Cybex/Orthotron (if available)

Strength
Beskrivning

Strength

Datatyp

text

Power
Beskrivning

Power

Datatyp

text

Thigh Circ: Right leg (10cm patella)
Beskrivning

Thigh Circ right

Datatyp

text

Thigh Circ: Left leg (10cm patella)
Beskrivning

Thigh Circ left

Datatyp

text

Capsule summary
Beskrivning

Capsule summary

Symptoms
Beskrivning

The Symptom score is the total score /4 of the entire symptom section

Datatyp

integer

Function
Beskrivning

The Function score is the score of the activity level question only

Datatyp

integer

Stability
Beskrivning

The Stability score comes from only the Ant Draw/Lach/Sublux portion of the P.E. as follows 5=none of the 3 tests > trace; 4=none of the 3 tests > 1 +; 3=two tests 1+ one test 2+; 2=two tests 2+ one test 1+; 1=all tests >= 2+.

Datatyp

integer

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Similar models

Anterior cruciate ligament follow-up form

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Identification
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Last Name
Item
Last Name
text
C1301584 (UMLS CUI [1])
First Name
Item
First Name
text
C1443235 (UMLS CUI [1])
Patient Initials
Item
Initials
text
C2986440 (UMLS CUI [1])
Social Security number
Item
SS #
integer
OFF number
Item
OFF #
text
Age
Item
Age
integer
C0001779 (UMLS CUI [1])
Item
Sex
text
C0079399 (UMLS CUI [1])
Sex
Code List
Sex
CL Item
M (M)
CL Item
F (F)
Item
Knee involved
text
Knee involved
Code List
Knee involved
CL Item
Right (Right)
CL Item
Left (Left)
Phone number
Item
Phone #
integer
Name of close person
Item
Name of someone who can reach you if you have moved
text
Phone number of close person
Item
Phone # of someone who can reach you if you have moved
integer
Date of surgery
Item
Date of surgery
date
Item
Number of months since surgery
integer
Number of months since surgery
Code List
Number of months since surgery
CL Item
6 (1)
CL Item
12 (2)
CL Item
18 (3)
CL Item
24 (4)
CL Item
36 (5)
Item Group
Post-OP course
Cast
Item
Cast?
boolean
duration rigid cast
Item
# weeks in rigid cast
integer
duration flexible/hinged cast
Item
# weeks in flexible/hinged cast
integer
Brace
Item
Brace?
boolean
Item
Current brace use?
text
Current brace use
Code List
Current brace use?
CL Item
Allt the time (Allt the time)
CL Item
Sports only (Sports only)
CL Item
No longer use (No longer use)
Physical Therapy
Item
Physical Therapy?
boolean
supervised physical therapy duration
Item
# months in supervised program (Cybex Ortholron etc.)
integer
physical therapy home program
Item
Are you still doing a regular home program?
boolean
Item Group
Symptoms
Item
Knee pain?
integer
Knee pain
Code List
Knee pain?
CL Item
None (4)
CL Item
Mild (3)
CL Item
Moderate (with activity) (2)
CL Item
Severe (at rest and preventing activity) (1)
Item
Giving way?
integer
Giving way
Code List
Giving way?
CL Item
None (8)
CL Item
Only with cutting (stop and turn) sports (6)
CL Item
Occasional (only with awkward step) (4)
CL Item
With normal daily activities (2)
Item
Swelling?
integer
Swelling
Code List
Swelling?
CL Item
None (4)
CL Item
Strenuous activity (3)
CL Item
With moderate activity (2)
CL Item
With any activity (1)
Item
Stiffness?
integer
Stiffness
Code List
Stiffness?
CL Item
None (4)
CL Item
Occasional (2)
CL Item
Frequent (1)
total points symptoms
Item
Symptom Total points
integer
Symptom Summary
Item
Symptom Summary = Total / 4
integer
Item Group
Function
Item
Activity level?
integer
Activity level
Code List
Activity level?
CL Item
No sports  (1)
CL Item
Sports activities significantly limited (2)
CL Item
Active, but different sports (3)
CL Item
Same sports, but lower performance level  (4)
CL Item
Equal performance at same sports as before injury (5)
function summary
Item
Function Summary (Activity level)
integer
Item
Problems with specific activities: Walking?
text
Walking
Code List
Problems with specific activities: Walking?
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item
Problems with specific activities: Running?
text
Walking
Code List
Problems with specific activities: Running?
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Can't do (Can't do)
Item
Problems with specific activities: Turn/Cut?
text
Walking
Code List
Problems with specific activities: Turn/Cut?
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Can't do (Can't do)
Item
Problems with specific activities: Jumping?
text
Walking
Code List
Problems with specific activities: Jumping?
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Can't do (Can't do)
Item
Problems with specific activities: Stairs?
text
Walking
Code List
Problems with specific activities: Stairs?
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Can't do (Can't do)
rating activity level
Item
If your prior injury activity level rates at 10, what does your current activity level rate?
integer
rating knee performance
Item
If your normal knee performs 100%, at what % does your operated knee perform?
integer
Item Group
Surgical Hx
Item
Type ACL Injury
text
Type ACL Injury
Code List
Type ACL Injury
CL Item
Acute (< 1 wk) (Acute (< 1 wk))
CL Item
Sub Acute (1-6 wks) (Sub Acute (1-6 wks))
CL Item
Chronic (>6 wks) (Chronic (>6 wks))
CL Item
Acute on Chronic (Acute on Chronic)
Item
Associated injury (acute or chronic)
text
Associated injury
Code List
Associated injury (acute or chronic)
CL Item
MCL (MCL)
CL Item
PCL (PCL)
CL Item
LCL (LCL)
CL Item
Med Men (Med Men)
CL Item
Lat Men (Lat Men)
Item
ACL Surgery
text
ACL Surgery
Code List
ACL Surgery
CL Item
No repair (No repair)
CL Item
Primary Repair without Augmentation (Primary Repair without Augmentation)
CL Item
Primary Repair Aug (Primary Repair Aug)
CL Item
Reconstruction (Reconstruction)
ACL Surgery Primary repair
Item
Primary Repair Aug with
text
ACL Surgery Reconstruction
Item
Reconstruction with
text
Item
Subsequent Injury
text
Subsequent Injury
Code List
Subsequent Injury
CL Item
None (None)
CL Item
Medical Meniscus (Medical Meniscus)
CL Item
Lateral Meniscus (Lateral Meniscus)
CL Item
ACL (ACL)
CL Item
MCL (MCL)
CL Item
LCL (LCL)
CL Item
PCL (PCL)
Item
Subsequent Surgery
text
Subsequent Surgery
Code List
Subsequent Surgery
CL Item
None (None)
CL Item
Hardware removal (Hardware removal)
CL Item
MUA (MUA)
CL Item
Menisectomy (Menisectomy)
CL Item
Ligament repair (Ligament repair)
Item Group
Stability
Anterior Drawer / Lachman right leg 15 degrees
Item
Anterior Drawer / Lachman: Right leg, 15°
text
Anterior Drawer / Lachman right leg 90 degrees
Item
Anterior Drawer / Lachman: Right leg, 90°
text
Anterior Drawer / Lachman left leg 15 degrees
Item
Anterior Drawer / Lachman: Left leg, 15°
text
Anterior Drawer / Lachman left leg 90 degrees
Item
Anterior Drawer / Lachman: Left leg, 90°
text
Subluxation right
Item
Subluxation (Pivot shift, Jerk, etc.): Right leg
text
Subluxation left
Item
Subluxation (Pivot shift, Jerk, etc.): Left leg
text
Varus right 0 degrees
Item
Varus: Right leg, 0°
text
Varus right 30 degrees
Item
Varus: Right leg, 30°
text
Varus left 0 degrees
Item
Varus: Left leg, 0°
text
Varus left 30 degrees
Item
Varus: Left leg, 30°
text
Valgus right 0 degrees
Item
Valgus: Right leg, 0°
text
Valgus right 30 degrees
Item
Valgus: Right leg, 30°
text
Valgus left 0 degrees
Item
Valgus: Left leg, 0°
text
Valgus left 30 degrees
Item
Valgus: Left leg, 30°
text
Range of motion right
Item
Range of motion: Right leg
integer
Range of motion left
Item
Range of motion: Left leg
integer
Item Group
Additional studies: X-ray
Item
Med joint DJD
text
Walking
Code List
Med joint DJD
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item
Lat joint DJD
text
Walking
Code List
Lat joint DJD
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item
P/F joint DJD
text
Walking
Code List
P/F joint DJD
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item
ICN osteophytes
text
Walking
Code List
ICN osteophytes
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Other X-ray
Item
Other (your favorite test)
text
Item Group
Additional studies: Cybex/Orthotron (if available)
Strength
Item
Strength
text
Power
Item
Power
text
Thigh Circ right
Item
Thigh Circ: Right leg (10cm patella)
text
Thigh Circ left
Item
Thigh Circ: Left leg (10cm patella)
text
Item Group
Capsule summary
Symptoms
Item
Symptoms
integer
Function
Item
Function
integer
Item
Stability
integer
Stability
Code List
Stability
CL Item
none of the 3 tests > trace (5)
CL Item
none of the 3 tests > 1 + (4)
CL Item
two tests 1+ one test 2+ (3)
CL Item
two tests 2+ one test 1+ (2)
CL Item
all tests >= 2+ (1)
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