Name Lysholm Knee Questionnaire Each question refers to your symptoms during the Last 4 weeks. All fields are required. Your Initials * Your DOB * 1. Limp * NoneSlight or periodical Severe and constant 2. Support * NoneStick or crutchWeight-bearing impossible 3. Locking * No locking and no catching sensationsCatching sensation but no lockingLocking OccasionallyFrequentlyLocked joint on examination 4. Instability * Never giving wayRarely during athletics or other severe exertionFrequently during athletics or other severe exertion (or incapable of participation)Occasionally in daily activitiesOften in daily activitiesEvery step 5. Pain * NoneInconstant and slight during severe exertionMarked during severe exertion Marked on or after walking more than 2 km Marked on or after walking less than 2 km Constant 6. Swelling * NoneOn severe exertionOn ordinary exertionConstant 7. Stair climbing * No problems Slightly impairedOne step at a time Impossible 8. Squatting * No problems Slightly impairedNot beyond 90°Impossible Score Total: Activity level Please choose your activity levels before the injury, activity level now and Activity level after surgery (if applicable) Before the injury Competitive sportsSoccer - National and International elite Competitive sportsSoccer - Lower divisions, Ice hockey, Wrestling, Gymnastics Competitive sportsBandy, Squash or badminton, Athletics (jumping, etc.), Downhill skiing Competitive sportsTennis, Athletics (running), Motorcross, Speedway, Handball, BasketballRecreational sportsSoccer, Bandy and ice hockey, Squash, Athletics (jumping), Cross-country track findings both recreational and competitive Recreational sportsTennis and badminton, Handball Basketball, Downhill skiing, Jogging at least five times per week Work Heavy labor(e.g., building, forestry)Competitive sportsCycling, Cross-country skiingRecreational sportsJogging on uneven ground at least twice weekly Work Moderately heavy labor (e.g., truck driving, heavy domestic work) Recreational sportsCycling, Cross-country skiing, Jogging on even ground at least twice weekly Work Light labor (e.g., nursing)Competitive and recreational sportsSwimming, Walking in forest possible Work Light laborWalking on uneven ground possible but impossible to walk in forest Work Sedentary work Walking on even ground possible Sick leave or disability pension because of knee problems Activity level now Competitive sportsSoccer - National and International elite Competitive sportsSoccer - Lower divisions, Ice hockey, Wrestling, Gymnastics Competitive sportsBandy, Squash or badminton, Athletics (jumping, etc.), Downhill skiing Competitive sportsTennis, Athletics (running), Motorcross, Speedway, Handball, BasketballRecreational sportsSoccer, Bandy and ice hockey, Squash, Athletics (jumping), Cross-country track findings both recreational and competitive Recreational sportsTennis and badminton, Handball Basketball, Downhill skiing, Jogging at least five times per week Work Heavy labor(e.g., building, forestry)Competitive sportsCycling, Cross-country skiingRecreational sportsJogging on uneven ground at least twice weekly Work Moderately heavy labor (e.g., truck driving, heavy domestic work) Recreational sportsCycling, Cross-country skiing, Jogging on even ground at least twice weekly Work Light labor (e.g., nursing)Competitive and recreational sportsSwimming, Walking in forest possible Work Light laborWalking on uneven ground possible but impossible to walk in forest Work Sedentary work Walking on even ground possible Sick leave or disability pension because of knee problems Activity level after surgery Competitive sportsSoccer - National and International elite Competitive sportsSoccer - Lower divisions, Ice hockey, Wrestling, Gymnastics Competitive sportsBandy, Squash or badminton, Athletics (jumping, etc.), Downhill skiing Competitive sportsTennis, Athletics (running), Motorcross, Speedway, Handball, BasketballRecreational sportsSoccer, Bandy and ice hockey, Squash, Athletics (jumping), Cross-country track findings both recreational and competitive Recreational sportsTennis and badminton, Handball Basketball, Downhill skiing, Jogging at least five times per week Work Heavy labor(e.g., building, forestry)Competitive sportsCycling, Cross-country skiingRecreational sportsJogging on uneven ground at least twice weekly Work Moderately heavy labor (e.g., truck driving, heavy domestic work) Recreational sportsCycling, Cross-country skiing, Jogging on even ground at least twice weekly Work Light labor (e.g., nursing)Competitive and recreational sportsSwimming, Walking in forest possible Work Light laborWalking on uneven ground possible but impossible to walk in forest Work Sedentary work Walking on even ground possible Sick leave or disability pension because of knee problems
