Open Access Research

Cross-cultural translation and measurement properties of the Polish version of the Knee injury and Osteoarthritis Outcome Score (KOOS) following anterior cruciate ligament reconstruction

Przemysław T Paradowski123*, Dariusz Witoński1, Rafał Kęska1 and Ewa M Roos4

Author Affiliations

1 Department of Reconstructive Surgery and Arthroscopy of the Knee Joint, Faculty of Health Sciences, Medical University, Radliński Hospital, Drewnowska 75, 91-002 Łódź, Poland

2 Department of Orthopedics, Sunderby Central Hospital of Norrbotten, SE-971 80 Luleå, Sweden

3 Department of Orthopedics, Haugesund Hospital, Helse Fonna, Karmsundgata 120, N-5528 Haugesund, Norway

4 Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark

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Health and Quality of Life Outcomes 2013, 11:107  doi:10.1186/1477-7525-11-107

Published: 27 June 2013



Knee Injury and Osteoarthritis Outcome Score (KOOS) is available in over 30 languages and a commonly used Patient-Reported Outcome (PRO) for assessment of treatment effects following knee surgery. The aim of the study was to report the linguistic translational process and evaluate the psychometric properties of the Polish version of the KOOS questionnaire.


We translated and culturally adapted the KOOS according to current guidelines for use in Poland. Patients who had undergone anterior cruciate ligament reconstruction (ACLR) completed the KOOS and Short Form 36 Health Survey (SF-36). We evaluated floor/ceiling effects, reliability (using Cronbach’s alpha, intraclass correlation coefficients (ICC) and measurement error), convergent and divergent construct validity (using four a priori stated hypotheses) and responsiveness (using data obtained prior to and one year after ACLR and described by both effect size (ES) and standardized response mean (SRM)).


The clinical study population consisted of 72 subjects (mean age 29.8, 28% women). We did not observe floor effects in any KOOS subscales neither pre- nor postoperatively. As expected, ceiling effects were found postoperatively for the subscales Pain and ADL in this cohort assessed on average 1.3 year after surgery as more than 15% reported no pain or limitations in daily activities. The Cronbach’s alpha was above 0.9 for all subscales indicating excellent internal consistency. The test-retest reliability of all KOOS subscales at one-year postoperatively was excellent with ICCs exceeding 0.86 for all subscales. The minimal detectable change on group level ranged from 1.3 to 2.4, and on an individual level from 10.9 to 20.2. Responsiveness was demonstrated since the expected pattern of effect sizes between subscales following ACLR was found.


We found the Polish version of the KOOS to be a valid and reliable instrument for use in patient groups having ACLR. We caution against monitoring individual patients since the smallest change considered clinically relevant cannot reliably be detected.

Knee injury and Osteoarthritis Outcome Score; Patient-reported outcome; Validation study; Psychometrics; Anterior cruciate ligament; Orthopedic surgery