Marshall et al developed a scoring system for the followup evaluation of athletes after knee ligament surgery. This can help monitor recovery and improvement in function after surgery. The authors are from the Hospital for Special Surgery in New York City.
Parameters:
(1) pain
(2) swelling
(3) using stairs
(4) clicking and/or numbness
(5) giving way
(6) return to sports/work
(7) functional tests: duck walk, run in place, jump on one leg, half squat, full squat
(8) specific knee examinations: tenderness, joint effusion, swelling of soft tissue, crepitations, muscle power
(9) thigh sizes
(10) range of motion
(11) stability of LCL (lateral collateral ligament)
(12) stability of MCL (medial collateral ligament)
(13) stability of ACL (anterior cruciate ligament)
(14) stability of PCL (posterior cruciate ligament)
|
Parameter |
Finding |
Points |
|---|---|---|
|
pain |
no |
1 |
|
|
yes |
0 |
|
swelling |
no |
1 |
|
|
yes |
0 |
|
difficulty with stairs |
no |
1 |
|
|
yes |
0 |
|
clicking and/or numbness |
no |
1 |
|
|
yes |
0 |
|
giving way |
regularly during daily activities |
0 |
|
|
with stress upon daily activities |
1 |
|
|
with stress only |
2 |
|
|
none |
4 |
|
return to sports or work |
no return |
0 |
|
|
return to different sport or work |
1 |
|
|
return to original sport or work but with limitations |
2 |
|
|
full return |
3 |
|
duck walk |
cannot perform |
0 |
|
|
can perform but with discomfort |
1 |
|
|
can perform |
2 |
|
run in place |
cannot do |
0 |
|
|
can |
1 |
|
jump on 1 leg |
cannot perform |
0 |
|
|
can perform but with discomfort |
1 |
|
|
can perform |
2 |
|
half squat |
cannot do |
0 |
|
|
can |
1 |
|
full squat |
cannot do |
0 |
|
|
can |
1 |
|
tenderness |
no |
1 |
|
|
yes |
0 |
|
joint effusion |
no |
1 |
|
|
yes |
0 |
|
swelling of soft tissue |
no |
1 |
|
|
yes |
0 |
|
creptitations |
no |
1 |
|
|
yes |
0 |
|
muscle power |
very weak |
0 |
|
|
diminished flexion AND extension |
1 |
|
|
diminished flexion OR extension |
2 |
|
|
normal |
3 |
|
thigh size |
> 2 cm difference |
0 |
|
|
1 – 2 cm difference |
1 |
|
|
equal (< 1 cm) |
2 |
|
range of motion |
< 90° |
0 |
|
|
limited flexion AND extension |
1 |
|
|
limited flexion OR extension |
2 |
|
|
normal |
3 |
|
stability LCL |
gross instability |
0 |
|
|
instability in flexion and extension |
2 |
|
|
moderate instability in flexion |
3 |
|
|
mild instability in flexion |
4 |
|
|
normal |
5 |
|
stability of MCL |
gross instability |
0 |
|
|
instability in flexion and extension |
2 |
|
|
moderate instability in flexion |
3 |
|
|
mild instability in flexion |
4 |
|
|
normal |
5 |
|
stability of ACL |
severe instability in neutral and rotation |
0 |
|
|
severe instability in neutral |
2 |
|
|
moderate jog |
3 |
|
|
slight jog |
4 |
|
|
normal |
5 |
|
stability of PCL |
severe instability in neutral and rotation |
0 |
|
|
severe in neutral |
2 |
|
|
moderate jog |
3 |
|
|
slight jog |
4 |
|
|
normal |
5 |
where:
• Normal for the ligament stability is based on the unaffected knee (if there is one).
• Rotation tests for the cruciate ligaments include the Pivot shift, Slocum, and jerk test.
• My guess is that "moderate jog" indicates moderate instability when jogging.
score =
= SUM(points for all parameters)
Interpretation:
• minimum score: 0
• maximum score: 50
• The higher the score, the more normal the knee.
• The lower the score, the less likely that the person can participate in most sports.
Purpose: To evaluate a patient after knee ligament surgery using the followup scoring scale of Marshall et al.
Specialty: Surgery, orthopedic
Objective: severity, prognosis, stage
ICD-10: M23,
