Arthroscopic knee surgeries are among the most common orthopaedic procedures,

accounting for 3 of the 10 most common orthopaedic procedures, and arthroscopic

meniscectomy is the most commonly performed orthopaedic surgery in the United States.3

The number of arthroscopic knee procedures continues to increase and increased 46% from

1996 to 2006.7 Despite the frequency of these procedures, little is known about the associated

complication rates.

In 1982, the Lysholm score was first described in the orthopaedic literature.11 The score was

designed to be physicianadministered and measure outcomes after knee ligament surgery. The score

emphasized the evaluation of instability and was intended to correspond with the patient’s own

opinion of function and signs of instability.11 In 1985, the Lysholm score was modified to be

adjusted for evaluation of meniscal injuries. This modification was achieved by introducing the

domain of locking. Furthermore, the domain of thigh atrophy was excluded. At the same time, the

Tegner activity scale was published.21 The Tegner activity scale was developed to complement the

Lysholm score. This new scale graded activity based on work and sports activities.21 It was

important to the authors to measure both function and activity level; however, due to differences in

the recovery process, they thought it was important that this was done in 2 different scores.

Moreover, the ability to perform in running and walking and the participation in recreational sports

were different levels on the International Classification of Impairments, Disabilities and Handicaps

(ICIDH).24 The authors stated that it was important that different levels of the ICIDH were evaluated

separately.20,23 Later on, the ICIDH was replaced with the ICF (International Classification of

Functioning, Disability and Health) of the same construct.25 Initially, both the Lysholm and the

Tegner scales were designed for physician administration. The Lysholm score was validated and

tested for reliability in patients with anterior cruciate ligament (ACL) injuries and meniscal
injuries.11,21 It had good criterion validity and test-retest reliability. Responsiveness was

determined for both scales in a study of nonoperative treatment of ACL injuries.

Over the past 25 years, researchers have continued to use these scores. In the last 5 years,

over 400 articles cited in PubMed have reported outcomes using the Lysholm score for knee injuries

and over 200 have reported the Tegner activity scale. These scores recently have been validated as

patient-administered instruments for use for other injuries of the knee, including meniscal, articular

cartilage, and patellar dislocations.3,6,9,13,15 The use of the Tegner activity scale has also extended

into other joints, including the hip and ankle.4 Since 1982, treatment of ACL injuries has changed.

Sources of tissue for ACL reconstruction grafts, techniques, rehabilitation programs, and patient

expectations have evolved. As rehabilitation programs have progressed, patients return to function

much earlier. In the early 1980s, most patients returned to sports at 1 year or longer after ACL

reconstruction. Currently, many patients return to sports at 6 to 9 months. Over the same period of

time, outcomes assessment has become a means of accountability. Consequently, new outcomes

scores have been developed for use with ACL injuries.12 With all these changes, the Lysholm score

and Tegner activity scale continue to be used. Both are most often used as patient-administered

instruments.