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Lysholm Knee Questionnaire / Tegner Activity Scale Name Date First Last Physician 1. Limp 5. Pain a None b Slight or periodical b Inconstant and slight during severe exertion c Severe and constant c Marked during severe exertion 2. Support d Marked on or after walking more than 2 km f Constant b Stick or crutch c Weight-bearing impossible 6. Swelling 3. Locking b On severe exertion a No locking and no catching sensations c On ordinary exertion b Catching sensation but no locking c Locking occasionally d Locking frequently e Locked joint on examination 7. Stair-climbing a No problems b Slightly impaired 4. Instability a Never giving way b Rarely during athletics or other severe exertion c Frequently during athletics or other severe exertion or incapable of participation c One step at a time d Impossible 8. Squatting d Occasionally in daily activities e Often in daily activities c Not beyond 90 f Every step Activity Level Before Injury Current Following Surgery if applicable Competitive sports Soccer - national and international elite Soccer lower divisions Ice hockey Wrestling Gymnastics Bandy Squash or badminton Athletics jumping etc* Downhill skiing Tennis Athletics running Motorcross speedway Handball Basketball Recreational sports Soccer Bandy and ice hockey Squash Cross-country track findings both recreational and competitive Tennis and badminton Jogging at least five times per week Work Heavy labor e*g* building forestry Cycling Jogging on uneven ground at least twice weekly Work Moderately heavy labor e*g* truck driving heavy domestic work Work Light labor e*g* nursing Competitive and recreational sports Swimming Walking in forest possible Walking on uneven ground possible but impossible to walk in forest Work Sedentary work Sick leave or disability pension because of knee problems Tegner Lysholm Score Print Form Submit. Support d Marked on or after walking more than 2 km f Constant b Stick or crutch c Weight-bearing impossible 6. Swelling 3. Locking b On severe exertion a No locking and no catching sensations c On ordinary exertion b Catching sensation but no locking c Locking occasionally d Locking frequently e Locked joint on examination 7. Swelling 3. Locking b On severe exertion a No locking and no catching sensations c On ordinary exertion b Catching sensation but no locking c Locking occasionally d Locking frequently e Locked joint on examination 7. Stair-climbing a No problems b Slightly impaired 4. Instability a Never giving way b Rarely during athletics or other severe exertion c Frequently during athletics or other severe exertion or incapable of participation c One step at a time d Impossible 8. Stair-climbing a No problems b Slightly impaired 4. Instability a Never giving way b Rarely during athletics or other severe exertion c Frequently during athletics or other severe exertion or incapable of participation c One step at a time d Impossible 8. Squatting d Occasionally in daily activities e Often in daily activities c Not beyond 90 f Every step Activity Level Before Injury Current Following Surgery if applicable Competitive sports Soccer - national and international elite Soccer lower divisions Ice hockey Wrestling Gymnastics Bandy Squash or badminton Athletics jumping etc* Downhill skiing Tennis Athletics running Motorcross speedway Handball Basketball Recreational sports Soccer Bandy and ice hockey Squash Cross-country track findings both recreational and competitive Tennis and badminton Jogging at least five times per week Work Heavy labor e*g* building forestry Cycling Jogging on uneven ground at least twice weekly Work Moderately heavy labor e*g* truck driving heavy domestic work Work Light labor e*g* nursing Competitive and recreational sports Swimming Walking in forest possible Walking on uneven ground possible but impossible to walk in forest Work Sedentary work Sick leave or disability pension because of knee problems Tegner Lysholm Score Print Form Submit.

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