PatientIQ Patient Portal

Symptoms

Grade symptoms at the highest activity level at which you think you could function without significant symptoms,even if you are not actually performing activities at this level.

What is the highest level of activity that you can perform without significant knee pain?

Very strenuous activities like jumping or pivoting as in basketball or soccer

Strenuous activities like heavy physical work, skiing or tennis

Moderate activities like moderate physical work, running or jogging

Light activities like walking, housework or yard work

Unable to perform any of the above activities due to knee pain

During the past 4 weeks, or since your injury, how often have you had pain?NeverConstant

If you have pain, how severe is it?No painWorst pain imaginable

What is the highest level of activity you can perform without significant swelling in your knee?

Very strenuous activities like jumping or pivoting as in basketball or soccer

Strenuous activities like heavy physical work, skiing or tennis

Moderate activities like moderate physical work, running or jogging

Light activities like walking, housework or yard work

Unable to perform any of the above activities due to knee swelling

During the past 4 weeks, or since your injury, did your knee lock or catch?

Yes

What is the highest level of activity you can perform without significant giving way in your knee?

Very strenuous activities like jumping or pivoting as in basketball or soccer

Strenuous activities like heavy physical work, skiing or tennis

Moderate activities like moderate physical work, running or jogging

Light activities like walking, housework or yard work

Unable to perform any of the above activities due to giving way of the knee

Sports Activities

What is the highest level of activity you can participate in on a regular basis?

Very strenuous activities like jumping or pivoting as in basketball or soccer

Strenuous activities like heavy physical work, skiing or tennis

Moderate activities like moderate physical work, running or jogging

Light activities like walking, housework or yard work

Unable to perform any of the above activities due to knee

IKDC 9

How does your knee affect your ability to:

	Not difficult at all	Minimally difficult	Moderately Difficult	Extremely difficult	Unable to do
Go up stairs
Go down stairs
Kneel on the front of your knee
Squat
Sit with your knee bent
Rise from a chair
Run straight ahead
Jump and land on your involved leg
Stop and start quickly

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Function

How would you rate the function of your knee on a scale of 0 to 10 with 10 being normal, excellent function and 0 being the inability to perform any of your usual daily activities which may include sports?

FUNCTION PRIOR TO YOUR KNEE INJURY:Couldn’t perform daily activitiesNo limitation in daily activities

CURRENT FUNCTION OF YOUR KNEE:Can’t perform daily activitiesNo limitation in daily activities

Outstanding Tasks0

Ikdc Test

IKDC

IKDC
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Ikdc Test

IKDC

IKDC
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Symptoms

Sports Activities

How does your knee affect your ability to:

Function

Ikdc Test

IKDC

IKDCForm

Ikdc Test

IKDC

IKDCForm

Symptoms

Sports Activities

How does your knee affect your ability to:

Function

IKDC
Form

IKDC
Form