The Lysholm Knee Scoring Scale is an 8-item patient-reported outcome measure used to assess knee symptoms and functional limitations. It is commonly used in knee ligament, meniscal and other knee injury contexts. Scores range from 0 to 100, with higher scores indicating better perceived knee function and fewer symptoms. It does not diagnose a condition or clear someone for sport on its own.
Knee symptoms can affect walking, stairs, squatting, running, sport, work tasks and confidence with movement.
The Lysholm Knee Scoring Scale, often called the Lysholm score, is a patient-reported outcome measure used to assess knee symptoms and function. It is widely used in research and clinical reporting for knee injuries, especially anterior cruciate ligament and meniscal presentations.
The scale assesses eight areas:
limp
support
locking
instability
pain
swelling
stair climbing
squatting
The Lysholm score is commonly scored from 0 to 100, where higher scores indicate fewer symptoms and better perceived function. It focuses mainly on symptoms and daily functional activities rather than detailed sport performance.
Outcome measure: Lysholm Knee Scoring Scale
Common names: Lysholm score, Tegner Lysholm Knee Score
Body region: Knee
Type: Patient-reported outcome measure
Number of items: 8
Score range: 0–100
Higher score means: Better perceived knee function and fewer symptoms
Lower score means: More knee symptoms or functional limitation
Common use: Knee ligament, ACL, meniscal and post-surgical outcome monitoring
Best used with: KOOS, IKDC, Tegner Activity Scale, strength testing, hop testing and functional assessment
Key limitation: It does not diagnose a knee condition or determine readiness to return to sport on its own
The Lysholm Knee Scoring Scale is a knee-specific patient-reported outcome measure.
It asks the client to choose responses that best describe their current knee symptoms and function.
The eight scored domains are:
Limp
Support
Locking
Instability
Pain
Swelling
Stair climbing
Squatting
The maximum score is 100 points. Higher scores indicate better perceived knee status.
The Lysholm score is often used with the Tegner Activity Scale, which provides additional context about the client’s activity level. The Lysholm score captures symptoms and function, while the Tegner scale helps describe activity demands.
The Lysholm score is used because knee symptoms and function are not always fully captured by physical tests alone.
A client may have improving range of motion or strength but still report:
swelling after activity
instability during turning
pain with stairs
difficulty squatting
locking or catching symptoms
need for support while walking
reduced confidence in daily tasks
The Lysholm score can help professionals:
establish a baseline
monitor knee symptoms over time
capture client-perceived function
compare progress across reassessments
support goal-setting conversations
combine self-reported outcomes with objective tests
improve progress reporting in Measurz
The score should support assessment reasoning. It should not be used as a stand-alone diagnosis, treatment decision or clearance measure.
The Lysholm score measures knee-related symptoms and functional limitations across eight domains.
This item reflects whether the client reports limping during walking.
It may provide context about:
pain during gait
confidence
weight-bearing tolerance
fatigue
functional compensation
This item reflects whether the client needs a cane, crutch or other support.
It may provide context about:
walking confidence
pain irritability
loading tolerance
current function
This item reflects catching, locking or mechanical symptoms.
It may provide context about:
movement confidence
mechanical symptom reporting
difficulty with smooth knee motion
It does not confirm a meniscal tear or mechanical lesion on its own.
This item reflects giving-way or instability symptoms.
It may provide context about:
confidence with movement
pivoting or turning tolerance
perceived knee control
fear of giving way
It does not confirm ligament injury on its own.
This item reflects pain severity and activity relationship.
It may provide context about:
pain during exertion
walking tolerance
persistent symptoms
pain-limited function
This item reflects perceived swelling.
It may provide context about:
post-activity response
irritation
load tolerance
recovery status
It does not identify the cause of swelling.
This item reflects difficulty climbing stairs.
It may provide context about:
quadriceps function
pain with loading
confidence
daily function
This item reflects difficulty squatting.
It may provide context about:
knee flexion tolerance
pain during load
confidence
functional capacity
The Lysholm score may be useful for:
exercise professionals
rehabilitation practitioners
strength and conditioning coaches
performance coaches
allied health support teams
movement assessment professionals
students learning outcome measures
professionals using Measurz or MAT for structured progress tracking
It may be relevant for clients with:
ACL injury or reconstruction
meniscal injury
knee ligament injury
post-surgical knee recovery
cartilage-related knee symptoms
patellar instability history
persistent knee pain
swelling or giving-way symptoms
functional limitation after knee injury
The Lysholm score has post-2000 psychometric evidence in ACL injury, meniscal injury and chondral disorder populations.
Use the Lysholm score when you want a brief patient-reported measure of knee symptoms and function.
It may be useful at:
initial assessment
onboarding
post-injury baseline
post-operative milestones
reassessment
return-to-running planning
return-to-training planning
progress review
discharge or long-term follow-up
The Lysholm score is most useful when repeated over time using the same scoring method.
Use caution when:
the client cannot complete the questionnaire independently
language or literacy affects responses
many items are missing
the client has not attempted the activities being scored
the score is being used as a diagnosis
the score is being used as return-to-sport clearance
symptoms are coming from multiple body regions
a more comprehensive knee outcome measure may be more appropriate
The Lysholm score should not be used to:
diagnose ACL injury
diagnose meniscal injury
confirm ligament injury
confirm cartilage injury
identify the exact cause of pain, swelling or locking
clear someone for sport
replace physical assessment
replace professional judgement
Lysholm Knee Scoring Scale questionnaire
Scoring guide or calculator
Measurz recording workflow
Client symptom and function notes
Baseline and retest dates
Optional related measures, such as:
Tegner Activity Scale
KOOS
IKDC Subjective Knee Form
ACL Quality of Life
knee range of motion
knee swelling assessment
quadriceps and hamstring strength
hop testing
single-leg squat
gait, running or sport assessment
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire helps us understand how your knee symptoms are affecting everyday function. It does not diagnose the problem by itself, but it helps us track changes over time.”
The Lysholm score can be completed:
on paper
digitally
independently
verbally, if assistance is needed
before a session
during reassessment
as part of a Measurz workflow
Ask the client to:
answer based on their current knee problem
choose the response that best matches their experience
answer every item where possible
avoid overthinking each item
ask for clarification if they do not understand the wording
complete the same version at each retest
Record whether the questionnaire was completed:
independently
digitally
on paper
verbally
with assistance
This supports repeatability and interpretation.
If help is required:
explain the instructions without leading the answer
avoid telling the client which option to choose
record that assistance was provided
use the same assistance approach at retest where possible
Do not guess missing responses.
If an item is missing:
record which item was missed
avoid calculating a final score if scoring guidance for missing items is not available
interpret cautiously if the result is incomplete
Published scoring guidance for missing Lysholm items is not always detailed in commonly available resources, so consistent completion is important.
Each of the eight items contributes a set number of points.
The total score ranges from 0 to 100.
Higher scores indicate better perceived knee status.
Common item weighting includes:
Limp: 5 points
Support: 5 points
Locking: 15 points
Instability: 25 points
Pain: 25 points
Swelling: 10 points
Stair climbing: 10 points
Squatting: 5 points
These item weights show that pain and instability contribute heavily to the total score.
Retest at meaningful time points, such as:
baseline
after a training block
after a rehabilitation phase
after a flare-up
before return to running
before return to sport
post-operative milestones
discharge or progress review
For consistency, record:
date
current activity level
recent flare-ups
recent training load
whether the client has returned to the activities being scored
any major changes in sport, work or daily demands
The Lysholm score is a self-report questionnaire, so it does not create physical testing risk.
However, marked worsening in reported locking, instability, swelling or pain may support further assessment or referral where appropriate.
The Lysholm score ranges from 0 to 100.
Higher scores indicate better perceived knee function and fewer symptoms.
Lower scores indicate more symptoms or greater functional limitation.
Some clinical resources use the following practical categories:
95–100: excellent
84–94: good
65–83: fair
less than 65: poor
These categories can provide broad communication context, but they should not be used as strict pass/fail thresholds. Interpretation should consider the client’s goals, activity demands, baseline score and related physical findings.
A high score may suggest:
fewer knee symptoms
less pain
better stair and squat tolerance
less perceived instability
less swelling
better daily function
A low score may suggest:
more knee pain
greater perceived instability
swelling or mechanical symptoms
difficulty with stairs or squatting
reduced confidence with activity
greater functional limitation
A Lysholm score does not prove:
the diagnosis
the injured structure
ACL integrity
meniscal tear presence
cartilage status
readiness to return to sport
whether imaging is required
whether one intervention caused the change
Example wording:
“Your Lysholm score suggests your knee symptoms are affecting daily function, especially pain and instability. This does not tell us exactly what structure is involved, but it helps us track how your knee feels and functions over time.”
For general fitness clients, the Lysholm score may help track how knee symptoms affect:
walking
stairs
squatting
gym training
routine daily activity
Interpretation cautions:
it may not capture higher-level sport detail
recent activity may influence responses
symptoms from other body regions may affect answers
For athletes, Lysholm can help track common knee symptoms such as pain, swelling and instability.
However, it should be paired with:
Tegner Activity Scale
KOOS Sport/Recreation
ACL Quality of Life, where relevant
strength testing
hop testing
change-of-direction assessment
sport-specific exposure tracking
A high Lysholm score should not be treated as return-to-sport clearance.
For older adults, the Lysholm score may provide a quick view of knee symptoms affecting stairs, squatting, support use and walking.
Interpretation cautions:
other health conditions may influence responses
arthritis-related symptoms may require broader outcome measures
KOOS may provide more detailed osteoarthritis-related quality-of-life information
For youth clients, consider:
reading level
comprehension
parent or guardian assistance
sport exposure
whether a youth-specific outcome measure would be more appropriate
If assistance is provided, record it clearly.
The Lysholm score is commonly used in ACL-related research and follow-up.
Post-2000 evidence supports acceptable psychometric properties and responsiveness in ACL injury populations, but interpretation should still include strength, hop testing, confidence and sport-specific measures.
The Lysholm score has been studied in meniscal injury populations and showed acceptable overall psychometric properties, although some individual domains had ceiling effects.
Interpretation should consider:
joint-line symptoms
swelling
locking or catching
squatting tolerance
stair function
sport-specific twisting demands
The Lysholm scale has also been assessed in people with chondral disorders, including traumatic and degenerative chondral lesions.
Interpretation should consider:
swelling response
pain with loading
activity exposure
sport goals
related imaging or medical information where available
For post-surgical clients, Lysholm can help monitor perceived symptoms and function over time.
Interpretation should consider:
surgery type
healing stage
restrictions
activity exposure
swelling and pain pattern
medical or surgical guidance where relevant
Meaningful change helps determine whether a score change is likely to matter.
Key terms:
MCID / MIC / MICD: the smallest change that may be meaningful to clients or professionals, depending on the method used
MDC: the amount of change likely needed to exceed measurement error
SEM: the estimated measurement error around a score
Responsiveness: the ability of the questionnaire to detect change over time
PASS: patient acceptable symptom state
SCB: substantial clinical benefit
A 2023 study calculated the minimal important clinical difference for the Lysholm and IKDC scores after ACL reconstruction. The study included people who had ACL reconstruction from March 2019 to December 2020, with at least 6 months of follow-up, and used an anchor question to estimate meaningful change.
A 2024 systematic review on surgical knee ligament reconstruction found that MCID, substantial clinical benefit and patient acceptable symptom state reporting needs better methodology and consistency. It noted that the IKDC, Lysholm and Tegner scores were the only instruments with multiple studies reporting values, but interpretation still requires caution.
When interpreting Lysholm change:
compare the total score with baseline
consider whether the change exceeds available MCID or MICD values for a matching population
check whether the change is consistent with pain, swelling and instability reports
compare score change with activity exposure
consider related physical tests
avoid over-interpreting small changes
Reported meaningful change values may vary by:
injury type
surgery type
time since injury or surgery
baseline severity
follow-up timeframe
anchor method
language version
activity level
When no matching MCID, MDC or SEM value is available, interpretation should rely more heavily on:
baseline comparison
repeated measurement
client-reported change
physical assessment findings
activity exposure
professional judgement
Published normative data for the Lysholm score are more limited than for some broader population PROMs.
A 2009 study examined Lysholm score and Tegner activity level in individuals with normal knees and noted that these tools are commonly used to document outcomes after arthroscopic knee surgery. This provides useful comparison context, but it should not be treated as a universal pass/fail standard.
Practical comparison guidance:
Use the client’s own baseline as the primary comparison.
Compare retest scores only when the same version and scoring method are used.
Consider activity exposure at each time point.
Interpret broad categories as communication aids, not strict thresholds.
Compare with related PROMs such as KOOS or IKDC when a broader view is needed.
Combine score change with physical findings such as swelling, ROM, strength and hop performance.
Reference values should be interpreted with caution because scores may differ by:
age
sex
injury type
sport level
surgery status
activity demands
symptom chronicity
population studied
The Lysholm score has post-2000 evidence supporting reliability, validity and responsiveness across several knee populations.
For meniscal injury, Briggs and colleagues reported that the overall Lysholm score showed acceptable test-retest reliability, floor and ceiling effects, criterion validity, construct validity and responsiveness to change. However, some individual domains had unacceptable ceiling effects, including limp, instability, support and locking.
For ACL injury, Briggs and colleagues reported that the Lysholm score and Tegner Activity Scale demonstrated acceptable psychometric parameters and responsiveness as patient-administered scores after ACL treatment.
For chondral disorders, a large study assessed test-retest reliability, internal consistency, content validity, criterion validity, construct validity and responsiveness in a heterogeneous group of 1,657 people with traumatic and degenerative chondral lesions.
Reliability and validity are stronger when:
the same questionnaire version is used
the client completes all items
the same scoring method is repeated
the score is interpreted in the right population
retesting occurs at meaningful time points
results are combined with physical assessment findings
Interpret cautiously when:
individual domains show ceiling effects
many items are missing
the client has not attempted relevant activities
symptoms are from multiple body regions
the score is used as a stand-alone clearance decision
sport performance is the main question, because Lysholm is not a detailed sport performance measure
Common errors include:
treating Lysholm as a diagnosis
using the score as return-to-sport clearance
not recording the version used
not recording completion method
ignoring missing items
over-interpreting small changes
ignoring activity exposure
using score categories as strict pass/fail cut-offs
relying on Lysholm alone for athletes
failing to pair it with physical testing
Limitations include:
limited sport-specific detail
some domains may show ceiling effects
total score may hide which symptom is driving limitation
self-report can be influenced by expectations and recent activity
meaningful change values vary by population
normative data are limited
it does not identify the exact cause of pain, swelling, locking or instability
The Lysholm score may help professionals:
document baseline knee symptom status
monitor change after knee injury
track pain, swelling and instability symptoms
support post-surgical follow-up
guide client education
compare self-reported function over time
strengthen Measurz reporting
For athletes, it can help track symptom burden but should be paired with:
Tegner Activity Scale
KOOS or IKDC
ACL Quality of Life where relevant
strength testing
hop testing
change-of-direction testing
sport-specific exposure tracking
For general population clients, it can help monitor:
walking
stairs
squatting
support needs
pain and swelling patterns
For Measurz users, Lysholm works best when recorded alongside:
pain score
knee swelling
knee range of motion
quadriceps strength
hamstring strength
single-leg squat
hop testing
client goals
Record:
outcome measure name: Lysholm Knee Scoring Scale
version used
date completed
completion method: paper, digital, interview or assisted
language/version used
condition or presentation being tracked
side involved: left, right or bilateral
total Lysholm score out of 100
score category if used: excellent, good, fair or poor
direction of scoring: higher score indicates better knee status
item-level notes if relevant:
limp
support
locking
instability
pain
swelling
stair climbing
squatting
missing items, if any
assistance provided, if any
current pain score, if relevant
current symptoms
current activity or sport exposure
key functional limitations
confidence or participation goals
baseline comparison
MCID/MICD comparison where supported
related physical assessment findings
interpretation notes
retest date
referral or further assessment notes where appropriate
Record whether the main limitation appears to be:
pain dominant
instability dominant
swelling dominant
mechanical symptom dominant
stair or squat limitation
mixed limitation
unclear due to incomplete responses
This improves:
repeatability
communication
client education
assessment reasoning
monitoring over time
team consistency
reporting quality
It measures self-reported knee symptoms and function across eight domains: limp, support, locking, instability, pain, swelling, stair climbing and squatting.
The eight items are weighted and added to produce a total score from 0 to 100.
Yes. Higher scores indicate better perceived knee function and fewer symptoms.
Some resources use 95–100 as excellent, 84–94 as good, 65–83 as fair and below 65 as poor. These categories should be used as broad context, not strict pass/fail thresholds.
No. It may describe symptoms commonly seen in knee injury populations, but it does not diagnose ACL, meniscal, cartilage or ligament injury.
It can support return-to-sport reasoning, but it should not be used as the only clearance measure. It should be paired with strength, hop, movement, confidence and sport-specific testing.
MCID or MICD values have been studied in specific populations, including after ACL reconstruction, but values vary by study and should only be applied when the client population and context match.
Often, yes. The Tegner Activity Scale can add useful activity-level context because Lysholm focuses more on symptoms and everyday functional limitations.
The Lysholm Knee Scoring Scale is an 8-item knee outcome measure.
It produces a total score from 0 to 100.
Higher scores indicate better perceived knee status.
It assesses limp, support, locking, instability, pain, swelling, stairs and squatting.
It does not diagnose a knee condition or clear a client for sport.
Evidence supports reliability, validity and responsiveness in ACL, meniscal and chondral populations, with some limitations.
Meaningful change values vary by population and should be matched carefully.
Measurz should record total score, item-level drivers, completion method, side, activity exposure, baseline comparison and related physical findings.
Briggs, K. K., Kocher, M. S., Rodkey, W. G., & Steadman, J. R. (2006). Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. The Journal of Bone and Joint Surgery. American Volume, 88(4), 698–705. https://doi.org/10.2106/JBJS.E.00339
Briggs, K. K., Lysholm, J., Tegner, Y., Rodkey, W. G., Kocher, M. S., & Steadman, J. R. (2009). The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. The American Journal of Sports Medicine, 37(5), 890–897. https://doi.org/10.1177/0363546508330143
Fajardo do Nascimento, B., da Rocha Lima, M. B., Dias Júnior, J. M., Antunes Filho, J., de Oliveira Campos, T. V., & Mendes Júnior, A. F. (2023). Calculation of the minimal important clinical difference of the Lysholm and IKDC scores after anterior cruciate ligament reconstruction. Revista Brasileira de Ortopedia, 58(2), 285–290. https://doi.org/10.1055/s-0042-1756330
Kocher, M. S., Steadman, J. R., Briggs, K. K., Sterett, W. I., & Hawkins, R. J. (2004). Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee. The Journal of Bone and Joint Surgery. American Volume, 86(6), 1139–1145.
Müller, S., et al. (2024). Minimal clinically important difference, patient-acceptable symptom state and substantial clinical benefit values for the most commonly used patient-reported outcome measures in surgical knee ligament reconstruction: A systematic review and meta-analysis. European Journal of Trauma and Emergency Surgery. https://doi.org/10.1007/s00068-024-02708-3
Prodromidis, A. D., Thivaios, G. C., Mourikis, A., Erginousakis, I. D., Nikolaou, V. S., Vlamis, J., & Chronopoulos, E. (2024). Patient-reported outcome measures used on patients with anterior cruciate ligament injury. Cureus, 16(7), e64546. https://doi.org/10.7759/cureus.64546
