About the Kujala Anterior Knee Pain Scale
The Kujala Anterior Knee Pain Scale (AKPS) is a widely-used, validated 13-item self-report questionnaire specifically designed to assess subjective symptoms and functional limitations in patients with anterior knee pain and patellofemoral disorders. Developed by Kujala and colleagues in 1993, it evaluates activities known to correlate with patellofemoral pain such as running, squatting, stair climbing, prolonged sitting, and jumping. The scale produces a single total score from 0 to 100, where 100 represents no pain or functional limitation. It has demonstrated high internal consistency, excellent test-retest reliability, and strong criterion-related validity, making it a standard outcome measure in sports medicine, orthopaedics, and physiotherapy for anterior knee pain assessment.
Medical Specialties
Anatomic Areas
Clinical Indications
Developer Information
The Kujala Anterior Knee Pain Scale was developed by Urho M. Kujala, Lasse H. Jaakkola, Seppo K. Koskinen, Simo Taimela, Markku Hurme, and Olavi Nelimarkka at the University of Turku, Finland. It was published in 1993 in Arthroscopy: The Journal of Arthroscopic & Related Surgery.
Copyright & Licensing
The Kujala AKPS is freely available for clinical and research use. The original questionnaire was published in Arthroscopy (1993;9:159-163). Proper citation of the original paper is requested when using the tool in research or publications.
Administration Instructions
For each question below, please select the response that best describes your current knee condition.
Scoring Methodology
The Kujala AKPS sums the point values from all 13 items. Each item has a different number of response options with assigned point values. Items assess limp (0-5), support (0-5), walking (0-5), stairs (0-10), squatting (0-5), running (0-10), jumping (0-10), prolonged sitting with knees flexed (0-10), pain (0-10), swelling (0-10), abnormal patellar movements/subluxations (0-10), atrophy of thigh (0-5), and flexion deficiency (0-5). The total score ranges from 0 to 100, where 100 indicates no anterior knee pain and 0 indicates maximum pain and disability. All 13 questions must be answered for a valid score.
Meaningful Change Threshold
A change of 10 points or more in the Kujala score is considered the minimal clinically important difference (MCID) and represents a meaningful change in anterior knee pain and function (Crossley et al. 2004). Changes of 14 points or greater have been reported as substantial clinical improvement.
Score Interpretation
Understanding what your score means
poor
0 - 44Poor outcome with severe anterior knee pain and significant functional limitation
fair
45 - 63Fair outcome with moderate anterior knee pain and noticeable functional limitation
good
64 - 82Good outcome with mild anterior knee pain and minimal functional limitation
excellent
83 - 100Excellent outcome with no significant anterior knee pain or functional limitation
Subscales
This questionnaire measures multiple dimensions
Kujala Score (0-100)
Overall measure of anterior knee pain and functional limitation
Clinical Limitations & Considerations
The Kujala AKPS is a self-reported questionnaire and may be influenced by patient recall bias or subjective perception of symptoms. It focuses specifically on anterior knee pain and patellofemoral disorders and may not be appropriate for other knee pathologies. Items 11 (patellar subluxations) and 12 (atrophy of thigh) may require clinical assessment to answer accurately. The questionnaire was originally validated in younger, active populations and may be less applicable to sedentary or elderly patients.
Supporting Literature
Key validation and development studies for the Kujala Anterior Knee Pain Scale
- 1
Scoring of patellofemoral disorders
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1993
- 2
Reliability and Validity of the Anterior Knee Pain Scale: Applications for Use as an Epidemiologic Screener
Ittenbach RF, Huang G, Barber Foss KD, Hewett TE, Myer GD
PLoS ONE, 2016
- 3
Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?
Crossley KM, Bennell KL, Cowan SM, Green S
Archives of Physical Medicine and Rehabilitation, 2004
- 4
Reliability and responsiveness of the lower extremity functional scale and the anterior knee pain scale in patients with anterior knee pain
Watson CJ, Propps M, Ratner J, Zeigler DL, Horton P, Smith SS
The Journal of Orthopaedic and Sports Physical Therapy, 2005
- 5
Anterior Knee Pain Scale: structural and criterion validity in Brazilian population with patellofemoral pain
Melo de Paula GM, Moreira D, de Oliveira FF, Mendonca LD, Serrão FV
BMC Musculoskeletal Disorders, 2024
- 6
Scoring of patellofemoral disorders
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1993
- 7
Reliability and Validity of the Anterior Knee Pain Scale: Applications for Use as an Epidemiologic Screener
Ittenbach RF, Huang G, Barber Foss KD, Hewett TE, Myer GD
PLoS ONE, 2016
- 8
Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?
Crossley KM, Bennell KL, Cowan SM, Green S
Archives of Physical Medicine and Rehabilitation, 2004
- 9
Reliability and responsiveness of the lower extremity functional scale and the anterior knee pain scale in patients with anterior knee pain
Watson CJ, Propps M, Ratner J, Zeigler DL, Horton P, Smith SS
The Journal of Orthopaedic and Sports Physical Therapy, 2005
- 10
Anterior Knee Pain Scale: structural and criterion validity in Brazilian population with patellofemoral pain
Melo de Paula GM, Moreira D, de Oliveira FF, Mendonca LD, Serrão FV
BMC Musculoskeletal Disorders, 2024
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