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ID
29001
Beschrijving
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
Trefwoorden
Versies (3)
- 16/02/18 16/02/18 -
- 20/02/18 20/02/18 -
- 09/05/18 09/05/18 - Halim Ugurlu
Houder van rechten
Feagin Jr, J. A.; Blake, W. P.
Geüploaded op
20 febbraio 2018
DOI
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Licentie
Creative Commons BY-NC 3.0
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Anterior cruciate ligament follow-up form
Anterior cruciate ligament follow-up form
- StudyEvent: ODM
Similar models
Anterior cruciate ligament follow-up form
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
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
Office number
Item
OFF #
text
Age
Item
Age
integer
C0001779 (UMLS CUI [1])
CL Item
M (M)
CL Item
F (F)
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
CL Item
6 (1)
CL Item
12 (2)
CL Item
18 (3)
CL Item
24 (4)
CL Item
36 (5)
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
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
CL Item
None (4)
CL Item
Mild (3)
CL Item
Moderate (with activity) (2)
CL Item
Severe (at rest and preventing activity) (1)
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)
CL Item
None (4)
CL Item
Strenuous activity (3)
CL Item
With moderate activity (2)
CL Item
With any activity (1)
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
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
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Can't do (Can't do)
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Can't do (Can't do)
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Can't do (Can't do)
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
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)
CL Item
MCL (MCL)
CL Item
PCL (PCL)
CL Item
LCL (LCL)
CL Item
Med Men (Med Men)
CL Item
Lat Men (Lat Men)
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
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)
CL Item
None (None)
CL Item
Hardware removal (Hardware removal)
CL Item
MUA (MUA)
CL Item
Menisectomy (Menisectomy)
CL Item
Ligament repair (Ligament repair)
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
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
CL Item
None (None)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
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
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
CL Item
R (R)
CL Item
L (L)
Quadriceps
Item
Quadriceps
text
Hamstrings
Item
Hamstrings
text
Symptoms
Item
Symptoms
integer
Function
Item
Function
integer
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)