One of the most common reasons for knee surgery is an injury to a person’s Anterior Cruciate Ligament (ACL). With that in mind, the Lysholm Knee Score is one of the most utilized scoring systems for ACL injuries and chondral defects.

The first version of the Lysholm scale was published in 1982 and consisted of eight questions that dealt with the categories of limping, support, locking, instability, pain, swelling, stair climbing, and squatting. A revised version of Lysholm was introduced in 1985 and added one item regarding knee locking, while removing other items relating to pain/swelling on giving way, the objective measurement of thigh atrophy and the reference to walking, running, and jumping [2].

Following these modifications, the Lysholm scoring scale reached the standard required to become a patient-reported outcome (PRO)tool, and as with all PRO tools, the modified questionnaire enhanced patient perspectives of their illness.

The Lysholm scale currently consists of eight items that asses: pain (25 points), instability (25 points), locking (15 points), swelling (10 points), limp (5 points), stair climbing (10 points), squatting (5 points), and need for support (5 points). Every question response has been assigned an arbitrary score on an increasing scale. The total score is the sum of each response to the eight questions, and may range from 0-100. Higher scores indicate a better outcome with fewer symptoms or disability.

What PRO tools are available for TKA patients?

We break them down in our Knee PRO Tools Guide.

Strengths

The Lysholm Knee Scoring Scale has an extended use beyond evaluating outcomes of knee ligament surgery. It can also be used for meniscal tears, knee cartilage lesions, osteochondritis dissecans, traumatic knee dislocation, patellar instability, patellofemoral pain, and knee osteoarthritis [2].

A study carried out by Briggs et al. showed the Lysholm questionnaire to have acceptable test-retest reliability, floor and ceiling effects, criterion validity, construct validity, and responsiveness to change [3].

Finally, the questionnaire itself is relatively easy for patients to complete and does not have a complicated scoring methodology.

 

Weaknesses

The Lysholm scale appears to have inadequate internal consistency in patients with a variety of knee conditions [2] and although test–retest reliability is adequate for use in groups with knee injuries, studies have found that it is less than adequate for patients with mixed knee pathologies [2].

License

The revised Lysholm tool is freely available in the original publication. No license or permission is required for use.

About CODE Technology

As we transition into value-based care, collecting patient-reported outcomes (PROs) has never been more important. But the process can be intimidating. That’s where CODE Technology comes in. We’re a PRO vendor that handles everything every aspect of PRO data collection for you as a service, 100% out of office. We collect, we report, we benchmark, and the data we collect assists with research, helps improve patient care, and gives leverage in negotiations with payers.

Don’t be intimidated by mountains of data. CODE will climb the cliff for you. See how our platform works or contact a PRO expert today to get a conversation started.

References

  1. 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 & Joint Surgery, 86(6), 1139-1145. http://www.ncbi.nlm.nih.gov/pubmed/15173285
  2. What knee scoring system? S. Tilley and N. Thomas http://www.boneandjoint.org.uk/content/focus/what-knee-scoring-system
  3. COLLINS NJ, MISRA D, FELSON DT, CROSSLEY KM, ROOS EM. Measures of Knee Function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis care & research. 2011;63(0 11):S208-S228. doi:10.1002/acr.20632. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336550/
  4. Reliability, Validity, and Responsiveness of the Lysholm Knee Score and Tegner Activity Scale for Patients with Meniscal Injury of the Knee. Karen K. Briggs, Mininder S. Kocher, William G. Rodkey, J. Richard Steadman, J Bone Joint Surg Am Apr 2006, 88 (4) 698-705; DOI: 10.2106/JBJS.E.00339, http://jbjs.org/content/88/4/698