ID

30085

Description

Evaluation 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

Mots-clés

16/02/2018 16/02/2018 -
20/02/2018 20/02/2018 -
09/05/2018 09/05/2018 - Halim Ugurlu

Détendeur de droits

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

Téléchargé le

9 mai 2018

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0

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29001_Anterior cruciate ligament follow-up form

model
Détails

Anterior cruciate ligament follow-up form

1 Formulaires

StudyEvent: ODM
1. Anterior cruciate ligament follow-up form

Name

Type

Description | Question | Decode (Coded Value)

Type de données

Alias

Identification

Item Group

Identification

C1269815 (UMLS CUI-1)

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

Social Security number

integer

C1301821 (UMLS CUI [1])

Office number

Item

Office number

text

C1301943 (UMLS CUI [1])

Age

Item

Age

integer

C0001779 (UMLS CUI [1])

Sex

Item

Sex

text

C0079399 (UMLS CUI [1])

Sex

Code List

Sex

CL Item

M (M)

CL Item

F (F)

Knee involved

Item

Knee involved

text

C0022742 (UMLS CUI [1])

Knee involved

Code List

Knee involved

CL Item

Right (Right)

CL Item

Left (Left)

Phone number

Item

Phone #

integer

C1515258 (UMLS CUI [1])

Name of close person

Item

Name of someone who can reach you if you have moved

text

C0337611 (UMLS CUI [1,1])
C0682339 (UMLS CUI [1,2])

Phone number of close person

Item

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

integer

C1515258 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0682339 (UMLS CUI [1,3])

Date of surgery

Item

Date of surgery

date

C1628561 (UMLS CUI [1])

Number of months since surgery

Item

Number of months since surgery

integer

C0543467 (UMLS CUI [1,1])
C1948053 (UMLS CUI [1,2])
C0032790 (UMLS CUI [1,3])
C0439231 (UMLS CUI [1,4])
C0449238 (UMLS CUI [1,5])

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)

Post-OP course

Item Group

Post-OP course

C0032790 (UMLS CUI-1)

Cast

Item

Cast?

boolean

C0179686 (UMLS CUI [1])

duration rigid cast

Item

# weeks in rigid cast

integer

C0179686 (UMLS CUI [1,1])
C0233850 (UMLS CUI [1,2])
C0449238 (UMLS CUI [1,3])

duration flexible/hinged cast

Item

# weeks in flexible/hinged cast

integer

C0179686 (UMLS CUI [1,1])
C0443220 (UMLS CUI [1,2])
C0449238 (UMLS CUI [1,3])

Brace

Item

Brace?

boolean

C0006086 (UMLS CUI [1])

Current brace use

Item

Current brace use?

text

C0006086 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])

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

C0949766 (UMLS CUI [1])

supervised physical therapy duration

Item

# months in supervised program (Cybex Ortholron etc.)

integer

C0695203 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])

physical therapy home program

Item

Are you still doing a regular home program?

boolean

C0475647 (UMLS CUI [1,1])
C0949766 (UMLS CUI [1,2])

Symptoms

Item Group

Symptoms

C1457887 (UMLS CUI-1)

Knee pain

Item

Knee pain?

integer

C0231749 (UMLS CUI [1])

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)

Giving way

Item

Giving way?

integer

C0231748 (UMLS CUI [1])

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)

Swelling

Item

Swelling?

integer

C0038999 (UMLS CUI [1])

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)

Stiffness

Item

Stiffness?

integer

C0427008 (UMLS CUI [1])

Stiffness

Code List

Stiffness?

CL Item

None (4)

CL Item

Occasional (2)

CL Item

Frequent (1)

total points symptoms

Item

Symptom Total points

integer

C2964552 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])

Symptom Summary

Item

Symptom Summary = Total / 4

integer

C1706244 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])

Function

Item Group

Function

C0234130 (UMLS CUI-1)

Activity level

Item

Activity level?

integer

C0683317 (UMLS CUI [1])

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

C1706244 (UMLS CUI [1,1])
C0234130 (UMLS CUI [1,2])

Walking

Item

Problems with specific activities: Walking?

text

C0080331 (UMLS CUI [1,1])
C0033213 (UMLS CUI [1,2])

Walking

Code List

Problems with specific activities: Walking?

CL Item

None (None)

CL Item

Mild (Mild)

CL Item

Moderate (Moderate)

CL Item

Severe (Severe)

Running

Item

Problems with specific activities: Running?

text

C0035953 (UMLS CUI [1,1])
C0033213 (UMLS CUI [1,2])

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)

Turn/Cut

Item

Problems with specific activities: Turn/Cut?

text

C0541749 (UMLS CUI [1,1])
C0033213 (UMLS CUI [1,2])

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)

Jumping

Item

Problems with specific activities: Jumping?

text

C0221189 (UMLS CUI [1,1])
C0033213 (UMLS CUI [1,2])

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)

Stairs

Item

Problems with specific activities: Stairs?

text

C0429980 (UMLS CUI [1,1])
C0033213 (UMLS CUI [1,2])

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

C0683317 (UMLS CUI [1])

rating knee performance

Item

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

integer

C1518965 (UMLS CUI [1,1])
C0022742 (UMLS CUI [1,2])

Surgical Hx

Item Group

Surgical Hx

C0262926 (UMLS CUI-1)
C0455610 (UMLS CUI-2)

Type ACL Injury

Item

Type ACL Injury

text

C0078960 (UMLS CUI [1,1])
C0449499 (UMLS CUI [1,2])

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)

Associated injury

Item

Associated injury (acute or chronic)

text

C0332281 (UMLS CUI [1,1])
C0449499 (UMLS CUI [1,2])

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)

ACL Surgery

Item

ACL Surgery

text

C0078960 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])

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

C0078960 (UMLS CUI [1,1])
C0406991 (UMLS CUI [1,2])

ACL Surgery Reconstruction

Item

Reconstruction with

text

C3178820 (UMLS CUI [1])

Subsequent Injury

Item

Subsequent Injury

text

C0332282 (UMLS CUI [1,1])
C3263723 (UMLS CUI [1,2])

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)

Subsequent Surgery

Item

Subsequent Surgery

text

C0332282 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])

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)

Stability

Item Group

Stability

C0205360 (UMLS CUI-1)

Anterior Drawer / Lachman right leg 15 degrees

Item

Anterior Drawer / Lachman: Right leg, 15°

text

C0231737 (UMLS CUI [1])
C3669150 (UMLS CUI [2,1])
C0230442 (UMLS CUI [2,2])
C0441889 (UMLS CUI [2,3])

Anterior Drawer / Lachman right leg 90 degrees

Item

Anterior Drawer / Lachman: Right leg, 90°

text

C0231737 (UMLS CUI [1])
C3669150 (UMLS CUI [2,1])
C0230442 (UMLS CUI [2,2])
C0441889 (UMLS CUI [2,3])

Anterior Drawer / Lachman left leg 15 degrees

Item

Anterior Drawer / Lachman: Left leg, 15°

text

C0231737 (UMLS CUI [1])
C3669150 (UMLS CUI [2,1])
C0230443 (UMLS CUI [2,2])
C0441889 (UMLS CUI [2,3])

Anterior Drawer / Lachman left leg 90 degrees

Item

Anterior Drawer / Lachman: Left leg, 90°

text

C0231737 (UMLS CUI [1])
C3669150 (UMLS CUI [2,1])
C0230443 (UMLS CUI [2,2])
C0441889 (UMLS CUI [2,3])

Subluxation right

Item

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

text

C2036827 (UMLS CUI [1])

Subluxation left

Item

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

text

C2036826 (UMLS CUI [1])

Varus right 0 degrees

Item

Varus: Right leg, 0°

text

C0443345 (UMLS CUI [1,1])
C0022745 (UMLS CUI [1,2])
C0205143 (UMLS CUI [1,3])
C0205090 (UMLS CUI [1,4])

Varus right 30 degrees

Item

Varus: Right leg, 30°

text

C0443345 (UMLS CUI [1,1])
C0022745 (UMLS CUI [1,2])
C0205143 (UMLS CUI [1,3])
C0205090 (UMLS CUI [1,4])

Varus left 0 degrees

Item

Varus: Left leg, 0°

text

C0443345 (UMLS CUI [1,1])
C0022745 (UMLS CUI [1,2])
C0205143 (UMLS CUI [1,3])
C0205091 (UMLS CUI [1,4])

Varus left 30 degrees

Item

Varus: Left leg, 30°

text

C0443345 (UMLS CUI [1,1])
C0022745 (UMLS CUI [1,2])
C0205143 (UMLS CUI [1,3])
C0205091 (UMLS CUI [1,4])

Valgus right 0 degrees

Item

Valgus: Right leg, 0°

text

C0443344 (UMLS CUI [1,1])
C0022745 (UMLS CUI [1,2])
C0205143 (UMLS CUI [1,3])
C0205090 (UMLS CUI [1,4])

Valgus right 30 degrees

Item

Valgus: Right leg, 30°

text

C0443344 (UMLS CUI [1,1])
C0022745 (UMLS CUI [1,2])
C0205143 (UMLS CUI [1,3])
C0205090 (UMLS CUI [1,4])

Valgus left 0 degrees

Item

Valgus: Left leg, 0°

text

C0443344 (UMLS CUI [1,1])
C0022745 (UMLS CUI [1,2])
C0205143 (UMLS CUI [1,3])
C0205091 (UMLS CUI [1,4])

Valgus left 30 degrees

Item

Valgus: Left leg, 30°

text

C0443344 (UMLS CUI [1,1])
C0022745 (UMLS CUI [1,2])
C0205143 (UMLS CUI [1,3])
C0205091 (UMLS CUI [1,4])

Range of motion right

Item

Range of motion: Right leg

integer

C2607871 (UMLS CUI [1,1])
C0230415 (UMLS CUI [1,2])

Range of motion left

Item

Range of motion: Left leg

integer

C2607871 (UMLS CUI [1,1])
C0230443 (UMLS CUI [1,2])

Additional studies X-ray

Item Group

Additional studies: X-ray

C1962945 (UMLS CUI-1)
C1524062 (UMLS CUI-2)

X-ray Med joint DJD

Item

Med joint DJD

text

C0409959 (UMLS CUI [1,1])
C0447799 (UMLS CUI [1,2])

Walking

Code List

Med joint DJD

CL Item

None (None)

CL Item

Mild (Mild)

CL Item

Moderate (Moderate)

CL Item

Severe (Severe)

X-ray lat joint DJD

Item

Lat joint DJD

text

C0409959 (UMLS CUI [1,1])
C0447800 (UMLS CUI [1,2])

Walking

Code List

Lat joint DJD

CL Item

None (None)

CL Item

Mild (Mild)

CL Item

Moderate (Moderate)

CL Item

Severe (Severe)

X-ray P/F joint DJD

Item

P/F joint DJD

text

C0409959 (UMLS CUI [1,1])
C0447801 (UMLS CUI [1,2])

Walking

Code List

P/F joint DJD

CL Item

None (None)

CL Item

Mild (Mild)

CL Item

Moderate (Moderate)

CL Item

Severe (Severe)

X-ray ICN osteophytes

Item

ICN osteophytes

text

C1956089 (UMLS CUI [1,1])
C0022745 (UMLS CUI [1,2])

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

C0034571 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])

Additional studies Cybex/Orthotron

Item Group

Additional studies: Cybex/Orthotron (if available)

C0008976 (UMLS CUI-1)
C0205394 (UMLS CUI-2)

Strength

Item

Strength

text

C0517349 (UMLS CUI [1,1])
C0542341 (UMLS CUI [1,2])

Power

Item

Power

text

C3854080 (UMLS CUI [1,1])
C0022742 (UMLS CUI [1,2])

Thigh Circ right

Item

Thigh Circ: Right leg (10cm patella)

text

C0230425 (UMLS CUI [1,1])
C1282913 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])

Thigh Circ left

Item

Thigh Circ: Left leg (10cm patella)

text

C0230426 (UMLS CUI [1,1])
C1282913 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])

hamstrings-to-quadriceps ratio

Item Group

Additional studies: hamstrings-to-quadriceps ratio

C0584895 (UMLS CUI-1)
C0224440 (UMLS CUI-2)
C0456603 (UMLS CUI-3)

Side

Item

Side

text

C0441987 (UMLS CUI [1])

Side

Code List

Side

CL Item

R (R)

CL Item

L (L)

Quadriceps

Item

Quadriceps

text

C0224440 (UMLS CUI [1])

Hamstrings

Item

Hamstrings

text

C0584895 (UMLS CUI [1])

Capsule summary

Item Group

Capsule summary

C0242482 (UMLS CUI-1)

Symptoms

Item

Symptoms

integer

C1457887 (UMLS CUI [1])

Function

Item

Function

integer

C0026606 (UMLS CUI [1])

Stability

Item

Stability

integer

C0205360 (UMLS CUI [1])

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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ID

Description

Mots-clés

Versions (3)

Détendeur de droits

Téléchargé le

DOI

Licence

Modèle Commentaires :

Groupe Item commentaires pour :

Item commentaires pour :

29001_Anterior cruciate ligament follow-up form

Anterior cruciate ligament follow-up form

Description

Alias

Description

Type de données

Alias

Description

Type de données

Alias

Description

Type de données

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Description

Type de données

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Type de données

Alias

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Type de données

Unités de mesure

Alias

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Type de données

Alias

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Type de données

Alias

Description

Type de données

Alias

Description

Type de données

Alias

Description

Type de données

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Type de données

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Type de données

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Alias

Description

Type de données

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Type de données

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Type de données

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Type de données

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Type de données

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