Patient-reported outcome measure
Tegner Calculator
Tegner Activity Scale
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.
What the Tegner score means
Tegner scores run from 0 to 10, where a higher score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.
- Unable to work because of the knee0–0
Sick leave or disability pension attributable to knee problems.
- Sedentary to light activity1–3
Walking and light work only, with swimming the most demanding sport represented.
- Moderate recreational activity4–6
Heavier work, cycling, skiing and regular jogging — straight-line activity with little cutting or pivoting.
- Demanding recreational or competitive sport7–8
Cutting, pivoting and jumping sports at recreational or sub-elite competitive level.
- Elite competitive sport9–10
Competitive contact and pivoting sport at divisional through to national and international level.
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 | 1 activity level | — | Patients with anterior cruciate ligament injury | — | Briggs KK 2009 |
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.
The patient or clinician selects the one level, from 0 to 10, whose work and sport descriptors match the highest activity the patient sustains. There is no arithmetic: the selected level is the score. Higher levels denote greater demand on the knee, with cutting, pivoting and contact sport concentrated at levels 7 and above and level 0 reserved for sick leave or a disability pension caused by the knee. Because the scale is ordinal, the levels are ranked but not equally spaced, and the conventional summary for a group is the median with the range. In practice the scale is recorded twice — the pre-injury level and the current level — and the difference between them is reported as the activity-level drop.
Missing data
A single response is required. If the pre-injury level is left blank the current level is still reported, but the activity-level change — the quantity most studies use — cannot be calculated and the result is flagged as incomplete.
Instrument profile
- Developer
- Yngve Tegner and Jack Lysholm
- Institution
- Linköping University, Sweden
- First published
- 1985
- Items
- 1
- Response format
- A single 11-level ordinal ladder, 0–10, recorded for the pre-injury and the current state
- Score range
- 0 to 10
- Direction
- Higher score = better
- Recall period
- Current activity level; the pre-injury entry refers to the level sustained before the index injury
- Completion time
- About 2 minutes
- Age range
- Adolescents and adults; the work and sport descriptors assume a working-age population
- Regions
- Knee
- Conditions
- ACL injury, Knee ligament injury, Meniscal injury, Cartilage injury, Knee instability
- Procedures
- ACL reconstruction, Meniscal repair, Meniscectomy, Cartilage repair
- Languages
- English, Swedish (original), Dutch, German, Brazilian Portuguese, Turkish, Persian, Chinese, and further validated translations
- Test–retest (ICC)
- Reported around 0.8 in knee ligament cohorts.
- Validity
- Designed as the activity companion to the Lysholm score and normally reported with it. Correlates with the Marx Activity Rating Scale, though the two are not interchangeable — Marx counts how often specific movements are performed, Tegner matches the patient to a named activity level.
- Responsiveness
- Detects the fall in activity after knee injury and the partial recovery after reconstruction. Because the scale is ordinal, change should be summarised as a median difference, not a mean.
- Ceiling effect
- Level 10 is limited to national and international elite competition, so there is no headroom above it and little discrimination among elite athletes.
- Floor effect
- Levels 0 to 2 compress a wide range of disability into three steps.
Normative values
Reference values from published cohorts, for comparison against the score you calculated.
| Population | Age | Mean | SD |
|---|---|---|---|
| Adults with no knee complaints | — | Median around 5 | — |
When to use the Tegner
Well suited to
- Recording activity level alongside a symptom score in knee ligament, meniscal and cartilage injury — the Lysholm and Tegner were written to be reported together.
- Quantifying the drop in activity after an ACL injury, and the extent of return after reconstruction.
- Case-mix description in registries and trials, where the activity level of the cohort changes how outcome scores should be read.
Limitations and poor fits
- As a standalone outcome measure — it says nothing about pain, swelling, instability or function.
- When interval-level statistics are required. The Marx Activity Rating Scale, being a sum of four frequency ratings, is easier to handle statistically.
- In older or sedentary populations, where the scale bottoms out and cannot distinguish among patients at levels 0 to 2.
- Without local adaptation in settings where the 1985 Swedish sport list does not correspond to what patients actually play.
Tegner compared with other instruments
Instruments measuring a related construct, with the practical difference between them.
| Instrument | Items | Range | What it adds |
|---|---|---|---|
| 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. |
| Lysholm | 8 | 0–100 | 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. |
| 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 Tegner scale has been published in full since 1985 and is reproduced openly throughout the orthopaedic literature. There is no active rights holder or licensing programme, and no permission is required to administer, score or reproduce it.
References
- Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clinical Orthopaedics and Related Research. 1985.
- 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.
- Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF. Development and evaluation of an activity rating scale for disorders of the knee. The American Journal of Sports Medicine. 2001.
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.