2015 ISAKOS Biennial Congress ePoster #1248

Differences in Marx and Koos Scores in Athletes Who Have Returned to Preinjury Activity and Those Who Have Not

Amelia J. H. Arundale, PT, DPT, SCS, Newark, DE UNITED STATES
Lynn Snyder-Mackler, PT, ScD, FAPTA, Newark, DE UNITED STATES

University of Delaware, Newark, DE, USA

FDA Status Not Applicable

Summary: Athletes who have not returned to preinjury level of activity at one year following ACLR report difficulty running, jumping, and kneeling as well as decreased quality of life compared to athletes who have returned.




Only approximately 66% of athletes return to their pre-injury level of sport after anterior cruciate ligament reconstruction (ACLR). Identifying differences in patient-reported function between athletes who have returned to their preinjury level of activity (RTA) and athletes who have not (noRTA) could help clinicians develop interventions to assist athletes achieve RTA. Self-report measures, such as the Marx Activity Rating Scale (Marx) and Knee injury Osteoarthritis Outcome Survey (KOOS), offer objective, patient-perceived information. Thus, the purpose of this study was to determine where differences exist in Marx and KOOS scores between athletes who had RTA and noRTA.


Seventy athletes were assessed one year following isolated ACLR using the Marx, KOOS, and RTA questions. A MANOVA was used to determine if differences existed in Marx and five KOOS subscale scores between the RTA and noRTA groups. If significant group differences existed, a MANOVA was used to assess which items these difference occurred. Significance was set a prior at p= 0.05.


Twenty five athletes were in the noRTA group. There were significant differences in Marx scores (RTA= 12.18±3.7, noRTA 8.32±4.2, p< 0.001), KOOS-Sport (RTA= 95.9± 5.6, noRTA=89.4±13.3, p=0.004) and KOOS-Quality of Life (QoL) (RTA= 84.7± 13.1, noRTA=73.5±17.9, p=0.003) scores. A significant difference was found for all four items of the Marx (running p=0.009, cutting p=0.002, decelerating p=0.006, and pivoting p=<0.001) with the RTA group scoring higher (running 3.25±0.15, cutting 2.89±0.17, decelerating 2.89±0.17, pivoting 3.16±0.15) than the noRTA group (running 2.60±0.19, cutting 1.96±0.23, decelerating 2.04±0.24, pivoting 1.72±0.21). There were also significant differences between groups on the items related to running (p=0.048), jumping (p=0.007) and kneeling (p=0.023) within the KOOS-Sport subscale. The RTA group had significantly better scores (running=0.09±0.29, jumping =0.11±0.32, kneeling =0.24±0.48) than the noRTA group (running= 0.29±0.55, jumping 0.46±0.72, kneeling=0.63±0.88). Differences between groups were also found in the KOOS-QoL subscale items related to lifestyle modification (p=0.001) and lack of confidence (p=0.001). Again, the RTA group had better scores (lifestyle= 0.33±0.56, confidence= 0.36±0.61) than the noRTA group (lifestyle= 0.96±0.86, confidence= 0.96±0.75).


noRTA athletes reported more difficulty with running, indicating that a fundamental part of cutting/pivoting sports was problematic for them. Further they also have more difficulty with jumping, but no significant difference existed between groups in pivoting. Together, jumping and running are the highest impact tasks on the KOOS, indicating that noRTA athletes may hesitate to load their involved knee. noRTA athletes also rate their QoL lower than RTA athletes. For noRTA athletes, lifestyle modifications including lower sports participation as seen with lower Marx scores, could contribute to a decreased QoL rating. Further self-confidence has been linked to sports participation and performance, also potentially contributing to this decreased QoL rating.

Clinical Relevance: Clinicians should utilize interventions to ensure an athlete’s comfort and confidence running and jumping prior to their discharge from rehabilitation to achieve RTA goals. Further, this study indicates that support in appropriate lifestyle modification and improving confidence surrounding the reconstructed knee may be of particular importance in achieving the highest possible QoL.