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EZFC Form #8

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Lysholm Knee Questionnaire

Each question refers to your symptoms during the Last 4 weeks. All fields are required.

None
Slight or periodical
Severe and constant
None
Stick or crutch
Weight-bearing impossible
No locking and no catching sensations
Catching sensation but no locking
Locking Occasionally
Frequently
Locked joint on examination
Never giving way
Rarely during athletics or other severe exrtion
Frequently during athletics or other seere exertion (or incapable of participation)
Occasionally in daily activities
Often in daily activities
Every step
None
Inconstant and slight during severe exertin
Marked during severe exertion
Marked on or aften salking more than 2 km
Marked on or aften walking less than 2 km
Constant
None
On severe exertion
On ordinary exertion
Constant
No problems
Slightly impaired
One step at a time
Impossible
No problems
Slightly impaired
Not beyond 90°
Impossible

Activity level

Please choose your activity levels before the injury, activity level now and Activity level after surgery (if applicable)

Sick leave or disability pension because of knee problems </b>
<b>Work</b>  ( Light labor ) Walking on uneven ground possible but impossible to walk in forest
<b>Work</b>  ( Light labor (e.g., nursing) / Competitive and recreational sports - Swimming, Walking in forest possible )
<b>Work </b>  ( Moderately heavy labor (e.g., truck driving, heavy domestic work) / Recreational sports - Cycling, Cross-country skiing, Jogging on even ground at least twice weekly )
<b>Work</b>   ( Heavy labor (e.g., building, forestry) / Competitive sports - Cycling, Cross-country skiing / Recreational sports - Jogging on uneven ground at least twice weekly )
<b>Recreational sports</b>  ( Tennis and badminton, Handball Basketball, Downhill skiing, Jogging at least five times per week )
<b>Competitive sports / Recreational sports</b>  (Competitive sports - Tennis, Athletics (running), Motorcross, Speedway, Handball, Basketball / Recreational sports - Soccer, Bandy and ice hockey, Squash, Athletics (jumping), Cross-country track findings both recreational and competitive)
<b>Competitive sports</b>  ( Bandy, Squash or badminton, Athletics (jumping, etc.), Downhill skiing )
<b>Competitive sports</b>  ( Soccer - Lower divisions, Ice hockey, Wrestling, Gymnastics )
<b>Competitive sports</b>   ( Soccer - National and International elite )
<b>Competitive sports</b>   ( Soccer - National and International elite )
<b>Competitive sports</b>  ( Soccer - Lower divisions, Ice hockey, Wrestling, Gymnastics )
<b>Competitive sports</b>  ( Bandy, Squash or badminton, Athletics (jumping, etc.), Downhill skiing )
<b>Competitive sports / Recreational sports</b>  (Competitive sports - Tennis, Athletics (running), Motorcross, Speedway, Handball, Basketball / Recreational sports - Soccer, Bandy and ice hockey, Squash, Athletics (jumping), Cross-country track findings both recreational and competitive)
<b>Recreational sports</b>  ( Tennis and badminton, Handball Basketball, Downhill skiing, Jogging at least five times per week )
<b>Work</b>   ( Heavy labor (e.g., building, forestry) / Competitive sports - Cycling, Cross-country skiing / Recreational sports - Jogging on uneven ground at least twice weekly )
<b>Work </b>  ( Moderately heavy labor (e.g., truck driving, heavy domestic work) / Recreational sports - Cycling, Cross-country skiing, Jogging on even ground at least twice weekly )
<b>Work</b>  ( Light labor (e.g., nursing) / Competitive and recreational sports - Swimming, Walking in forest possible )
<b>Work</b>  ( Light labor ) Walking on uneven ground possible but impossible to walk in forest
<b> Sick leave or disability pension because of knee problems </b>
<b>Competitive sports</b>   ( Soccer - National and International elite )
<b>Competitive sports</b>  ( Soccer - Lower divisions, Ice hockey, Wrestling, Gymnastics )
<b>Competitive sports</b>  ( Bandy, Squash or badminton, Athletics (jumping, etc.), Downhill skiing )
<b>Competitive sports / Recreational sports</b>  (Competitive sports - Tennis, Athletics (running), Motorcross, Speedway, Handball, Basketball / Recreational sports - Soccer, Bandy and ice hockey, Squash, Athletics (jumping), Cross-country track findings both recreational and competitive)
<b>Recreational sports</b>  ( Tennis and badminton, Handball Basketball, Downhill skiing, Jogging at least five times per week )
<b>Work</b>   ( Heavy labor (e.g., building, forestry) / Competitive sports - Cycling, Cross-country skiing / Recreational sports - Jogging on uneven ground at least twice weekly )
<b>Work </b>  ( Moderately heavy labor (e.g., truck driving, heavy domestic work) / Recreational sports - Cycling, Cross-country skiing, Jogging on even ground at least twice weekly )
<b>Work</b>  ( Light labor (e.g., nursing) / Competitive and recreational sports - Swimming, Walking in forest possible )
<b>Work</b>  ( Light labor ) Walking on uneven ground possible but impossible to walk in forest
<b> Sick leave or disability pension because of knee problems </b>

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