Patient-reported outcome measure
Lysholm Calculator
Lysholm Knee Scoring Scale
The Lysholm Knee Scoring Scale is an eight-domain questionnaire that rates knee symptoms and function — limp, support, locking, instability, pain, swelling, stair climbing and squatting — on a 0 to 100 scale, where 95 and above is graded excellent, 84 to 94 good, 65 to 83 fair, and below 65 poor.
What the Lysholm score means
Lysholm scores run from 0 to 100, where a higher score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.
- Poor0–64
Symptoms interfere with daily activity. In ligament and cartilage cohorts this range usually means unresolved instability, mechanical symptoms or persistent pain.
- Fair65–83
Sport and demanding activity are limited, but the knee is largely usable for daily life.
- Good84–94
Minor residual symptoms, typically on exertion only.
- Excellent95–100
No or near-no symptoms. Uninjured adults commonly score in this range, which is why the scale cannot show further improvement here.
Clinically important thresholds
A change in score only matters if it exceeds the smallest difference patients actually notice. Every threshold below is reported with the population it was derived in — a threshold quoted without its population is not usable.
| Type | Value | Subscale | Population | Follow-up | Source |
|---|---|---|---|---|---|
| MCID | 8.9 points | — | Patients with chondral disorders of the knee | — | Kocher MS 2004 |
MCID is the smallest change a patient perceives as meaningful. PASS is the score above which patients consider their state acceptable. SCB is a substantial rather than minimal benefit. MDC is the smallest change exceeding measurement error.
How the score is calculated
Stated in full so the calculation can be independently checked, and reproduced by hand if needed.
Each of the eight domains contributes a fixed number of points, and the eight selected values are added together to give a total out of 100. The maximum available per domain is unequal and reflects the developers' weighting: instability 25, pain 25, locking 15, swelling 10, stair climbing 10, limp 5, support 5 and squatting 5. A higher score means fewer symptoms — 100 is a symptom-free knee. There is no normalisation, no reverse scoring and no rounding; the total is a plain sum. The published grading is 95–100 excellent, 84–94 good, 65–83 fair and below 65 poor.
Missing data
The developers publish no imputation rule, and a Lysholm total is only valid when all eight domains are answered. This calculator shows a running subtotal while domains are outstanding, labels the result incomplete and withholds the grade until every domain has a response.
Instrument profile
- Developer
- Jack Lysholm and Jan Gillquist; modified by Yngve Tegner and Jack Lysholm
- Institution
- Linköping University, Sweden
- First published
- 1982
- Items
- 8
- Response format
- Eight multiple-choice domains with unequal point weights, summed to a maximum of 100
- Score range
- 0 to 100
- Direction
- Higher score = better
- Recall period
- Current state of the knee; the instrument specifies no fixed recall window
- Completion time
- About 4 minutes
- Age range
- Adults and adolescents; most validation samples are aged 15–60
- Regions
- Knee
- Conditions
- ACL injury, Knee ligament injury, Meniscal injury, Chondral and osteochondral lesions, Knee instability
- Procedures
- ACL reconstruction, Meniscal repair, Meniscectomy, Microfracture, Cartilage repair
- Languages
- English, Swedish (original), Dutch, German, Brazilian Portuguese, Turkish, Persian, Chinese, and further validated translations
- Test–retest (ICC)
- Reported around 0.9 in ACL, meniscal and chondral cohorts.
- Internal consistency
- Cronbach's alpha has been reported below the conventional 0.70 threshold (around 0.65). The eight domains describe related but distinct problems and do not behave as a single unidimensional construct, which is the main psychometric criticism of the scale.
- Validity
- Acceptable construct and criterion validity against the IKDC Subjective Knee Form, the KOOS, the SF-36 and the Tegner activity scale in ACL injury, meniscal injury and chondral disorders.
- Responsiveness
- Responsive after ACL reconstruction and cartilage procedures, though change is dominated by the instability and pain domains, which together hold half the available points.
- Ceiling effect
- Marked ceiling effect in young, high-demand patients after successful surgery: uninjured adults commonly score in the mid-90s, so there is little headroom to detect further improvement.
- Floor effect
- Floor effects are uncommon — the domains reach genuinely disabled states before the scale runs out.
Normative values
Reference values from published cohorts, for comparison against the score you calculated.
| Population | Age | Mean | SD |
|---|---|---|---|
| Adults with no knee complaints | — | Approximately 94 | — |
When to use the Lysholm
Well suited to
- Following ACL or other ligament reconstruction, where the 25-point instability domain is the reason the scale was written.
- Meniscal and chondral procedures, where locking and catching matter and shorter general knee scores do not ask about them.
- When a short, single-number knee score is needed alongside an activity measure, and the burden of a 42-item KOOS is not justified.
Limitations and poor fits
- Knee osteoarthritis and arthroplasty populations — the scale was derived in ligament injury and its instability and locking weighting does not fit degenerative knees; use the KOOS, KOOS JR or WOMAC.
- Young, highly active patients whose symptoms are already mild, because of the ceiling effect.
- Anterior knee pain and patellofemoral disorders, where the Kujala scale asks the relevant questions and the Lysholm does not.
- As a measure of activity level: a patient can score 100 by avoiding everything that provokes the knee. Report the Tegner or Marx score with it.
Lysholm compared with other instruments
Instruments measuring a related construct, with the practical difference between them.
| Instrument | Items | Range | What it adds |
|---|---|---|---|
| Tegner | 1 | 0–10 | The Tegner Activity Scale is a single-item ordinal ladder that grades a patient's work and sport activity from 0 (sick leave or disability pension because of knee problems) to 10 (national or international elite competitive sport), and is normally recorded twice — the pre-injury level and the current level — so that the drop between them can be reported. |
| Marx | 4 | 0–16 | The Marx Activity Rating Scale measures how frequently a patient runs, cuts, decelerates and pivots in their healthiest state over the past year, scoring each on a 0 to 4 frequency scale for a total of 0 to 16, where a higher score means a more demanding activity level. |
| IKDC | 18 | 0–100 | The IKDC Subjective Knee Evaluation Form is an 18-item patient-reported questionnaire covering knee symptoms, sports and daily activity and current knee function, whose raw total is transformed to a 0 to 100 score where 100 means no symptoms and no activity limitation — it requires permission from the AOSSM, so the items are not reproduced here. |
| KOOS | 42 | 0–100 | The KOOS is a 42-item patient-reported questionnaire that scores knee function as five separate subscales — Symptoms, Pain, Activities of Daily Living, Sport and Recreation, and Quality of Life — each from 0 (extreme problems) to 100 (no problems). |
Copyright and permitted use
Published openly because it is the question every clinician and researcher asks before using an instrument, and almost nobody answers it.
The Lysholm scale has been published in full in the peer-reviewed literature since 1982 and its modified 1985 form is reproduced openly in that literature. There is no active rights holder or licensing programme, and no permission is required to administer, score or reproduce it.
References
- Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. The American Journal of Sports Medicine. 1982.
- Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clinical Orthopaedics and Related Research. 1985.
- Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee. The Journal of Bone and Joint Surgery (American). 2004.
- Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. 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. 2009.
- Briggs KK, Steadman JR, Hay CJ, Hines SL. Lysholm score and Tegner activity level in individuals with normal knees. The American Journal of Sports Medicine. 2009.
- Briggs KK, Kocher MS, Rodkey WG, Steadman JR. 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). 2006.
Editorial status
Not yet reviewedQueued for clinical review by Sam Tuffun, PT, DPT. Sign-off has not taken place — this is a placeholder assignment, not a completed review.