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.

Introduction

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.  

Quick Summary

• 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

What Is the Lysholm Knee Scoring Scale?

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.

Why It Is Used

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.

What It Measures

The Lysholm score measures knee-related symptoms and functional limitations across eight domains.

Limp

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

Support

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

Locking

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.

Instability

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.

Pain

This item reflects pain severity and activity relationship.

It may provide context about:

• pain during exertion
• walking tolerance
• persistent symptoms
• pain-limited function

Swelling

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.

Stair Climbing

This item reflects difficulty climbing stairs.

It may provide context about:

• quadriceps function
• pain with loading
• confidence
• daily function

Squatting

This item reflects difficulty squatting.

It may provide context about:

• knee flexion tolerance
• pain during load
• confidence
• functional capacity

Who It Is Useful For

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.  

When to Use This Outcome Measure

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.

When Not to Use or When to Be Cautious

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

Equipment or Resources Required

• 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

Administration Protocol / Practice

Setup

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.”

Format

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

Client Instructions

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

Completion Method

Record whether the questionnaire was completed:

• independently
• digitally
• on paper
• verbally
• with assistance

This supports repeatability and interpretation.

Assistance Rules

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

Missing Item Handling

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.

Scoring Process

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.

Retesting Considerations

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

Safety Notes

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.

Scoring and Interpretation

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.

Common Score Categories

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.

What a High Score May Suggest

A high score may suggest:

• fewer knee symptoms
• less pain
• better stair and squat tolerance
• less perceived instability
• less swelling
• better daily function

What a Low Score May Suggest

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

What the Score Does Not Prove

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

How to Explain the Result Safely

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.”

What the Score May Mean in Different Client Populations

General Fitness Clients

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

Sport and Performance Clients

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.

Older Adults

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

Youth Clients

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.

Clients With ACL Injury or Reconstruction

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.  

Clients With Meniscal Injury

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

Clients With Cartilage or Chondral Disorders

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

Post-Surgical Clients

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, MCID, MDC and Responsiveness

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

Lysholm Meaningful Change Evidence

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.  

Practical Interpretation

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

When Values Are Uncertain

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

Normative Data, Reference Values or Comparative Data

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

Reliability and Validity

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 and Limitations

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

Practical Applications

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

How to Record This in Measurz

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

Related Outcome Measures / Internal Links

• Knee Injury and Osteoarthritis Outcome Score / KOOS
• ACL Quality of Life
• Lower Extremity Functional Scale / LEFS
• Foot and Ankle Outcome Score / FAOS
• Foot & Ankle Disability Index / FADI
• Hip Disability and Osteoarthritis Outcome Score / HOOS
• Copenhagen Hip and Groin Outcome Score / HAGOS
• Pain Self-Efficacy Questionnaire / PSEQ
• Tampa Scale for Kinesiophobia / TSK

FAQs

What does the Lysholm Knee Scoring Scale measure?

It measures self-reported knee symptoms and function across eight domains: limp, support, locking, instability, pain, swelling, stair climbing and squatting.

How is the Lysholm score calculated?

The eight items are weighted and added to produce a total score from 0 to 100.

Does a higher Lysholm score mean better knee function?

Yes. Higher scores indicate better perceived knee function and fewer symptoms.

What is a good Lysholm score?

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.

Does the Lysholm score diagnose ACL or meniscal injury?

No. It may describe symptoms commonly seen in knee injury populations, but it does not diagnose ACL, meniscal, cartilage or ligament injury.

Can Lysholm be used for return-to-sport decisions?

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.

Is there an MCID for the Lysholm score?

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.

Should Lysholm be used with Tegner?

Often, yes. The Tegner Activity Scale can add useful activity-level context because Lysholm focuses more on symptoms and everyday functional limitations.

Key Takeaways

• 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.

References

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