This 1985 paper by Tegner and Lysholm analyzes how different outcome rating systems capture disability after knee ligament injury in 76 ACL-injured patients. It compares a symptom-only numerical score (Lysholm) to a multi-domain binary/score hybrid (Marshall), and introduces the Tegner Activity Scale as a required complement. The central argument: no single score captures the full picture without knowing what the patient is actually doing.
When you ask an ACL patient 'how's your knee doing?' and they say fine, ask what they're actually doing. A patient who has quietly stopped playing recreational soccer will score well on the Lysholm scale while hiding exactly the deficit you care about.
This paper is why we use the Tegner Activity Scale alongside the Lysholm score, not instead of it. The Lysholm tells you how symptomatic the knee is at whatever activity the patient is currently doing. The Tegner tells you whether that activity level has already dropped from a 7 to a 3.
In practice, document pre-injury Tegner level at the first visit and track it through rehabilitation. Return to a pre-injury Tegner level is a more meaningful endpoint than Lysholm score improvement alone.
One methodological caution the authors flag: the Tegner scale was designed as a physician-administered tool, and results between individual patients should be interpreted with care given the subjective nature of activity self-categorization.
This 1985 paper by Tegner and Lysholm analyzes how different outcome rating systems capture disability after knee ligament injury in 76 ACL-injured patients. It compares a symptom-only numerical score (Lysholm) to a multi-domain binary/score hybrid (Marshall), and introduces the Tegner Activity Scale as a required complement. The central argument: no single score captures the full picture without knowing what the patient is actually doing.
When you ask an ACL patient 'how's your knee doing?' and they say fine, ask what they're actually doing. A patient who has quietly stopped playing recreational soccer will score well on the Lysholm scale while hiding exactly the deficit you care about.
This paper is why we use the Tegner Activity Scale alongside the Lysholm score, not instead of it. The Lysholm tells you how symptomatic the knee is at whatever activity the patient is currently doing. The Tegner tells you whether that activity level has already dropped from a 7 to a 3.
In practice, document pre-injury Tegner level at the first visit and track it through rehabilitation. Return to a pre-injury Tegner level is a more meaningful endpoint than Lysholm score improvement alone.
One methodological caution the authors flag: the Tegner scale was designed as a physician-administered tool, and results between individual patients should be interpreted with care given the subjective nature of activity self-categorization.