Lysholm

For Medical Students

What It Tests

The Lysholm score asks about the symptoms and the limitations that follow a ligament injury, including instability, locking, swelling, stair climbing and squatting. 4.2.2 covers instability.

The examination's interest is that it was built for one kind of problem, so it asks directly about the symptoms that problem causes. 4.22.1 covers the IKDC.

It matters that a condition specific instrument asks better questions for that condition and worse ones for everything else. 4.22.5 covers the Oxford Knee Score.

How It Is Performed

Give the questionnaire to the patient to complete themselves, before the consultation.

Explain the recall period.

Check completeness before scoring. 4.1.8 covers examination documentation.

Score it with the published method.

Record the score with its date and with the condition it is being used for, since its interpretation depends on that. 4.1.8 covers examination documentation.

Record the examination separately. 4.1.4 covers the structured approach.

Consider whether a different instrument fits the patient better before using this one. 4.22.2 covers the KOOS.

What a Positive Means

A score is read against the same patient's earlier score and against the condition it was designed for.

A low score in a ligament injured knee reflects the symptoms the instrument asks about, which is its intended use. 4.2.2 covers instability.

A score used in an arthritic knee answers questions that are not the main ones for that patient. 4.22.5 covers the Oxford Knee Score.

A high score in an athlete does not establish readiness for sport, which is a separate assessment. 4.21.7 covers return to sport testing.

An incomplete questionnaire is unscored.

No item count, score range or validation figure appears on this page. Those are properties of a published instrument and stating one from memory is the same class of claim as an invented citation, so the page describes what the instrument does and a reviewer with the questionnaire can add the numbers.

MRCS Level

How It Is Performed

In a viva this is the instrument to name for ligament injury, with the caveat about its age.

The expected points are the self completion, the timing, the completeness, the published scoring, the record with the condition, the separate examination record and the choice of instrument.

Say that it is condition specific and name the condition. 4.2.2 covers instability.

Say that you would consider whether another instrument fits better. 4.22.2 covers the KOOS.

Say that a questionnaire and a functional battery are different assessments. 4.21.7 covers return to sport testing.

What a Positive Means

The reasoning expected is that a condition specific instrument weights the items that matter for that condition, which makes it sensitive there and insensitive elsewhere. 4.22.1 covers the IKDC.

An older instrument reflects the understanding and the activities of its period, which is why its content is reviewed before use. 4.22.8 covers the use of these scores.

Mixing clinician assessed and patient reported items in one score makes the result harder to attribute, which is a known criticism of the older instruments. 4.1.8 covers examination documentation.

A score built for instability does not measure arthritic burden, which is why the instrument is chosen for the patient. 4.22.5 covers the Oxford Knee Score.

How Good It Is

The instrument is reproducible and remains in use largely because of the comparability it offers with older literature.

Its best contribution is asking directly about instability and mechanical symptoms, which the general instruments ask about less. 4.2.7 covers mechanical symptoms.

It is a poor fit for arthritic and patellofemoral problems.

No examination finding corresponds to it. 4.1.6 covers that relationship.

No figures appear for any accuracy comparison on this page, under decision 023, and the comparison is the claim being made.

No item count, score range or validation figure appears on this page. Those are properties of a published instrument and stating one from memory is the same class of claim as an invented citation, so the page describes what the instrument does and a reviewer with the questionnaire can add the numbers.

FRCS Level

How Good It Is

At decision level the instrument's role is narrow and defensible within that range.

Comparability with the older literature is a real reason to use it, and it is a research reason rather than a clinical one. 4.22.8 covers the use of these scores.

A ligament injured patient followed with this score has a record that compares with historical series. 4.20.1 covers the reconstruction assessment.

A patient with mixed pathology needs a general instrument instead, and the examination is what identifies the mix. 4.22.1 covers the IKDC.

Using two instruments to cover both purposes doubles the completion burden, which is a service decision. 4.1.8 covers examination documentation.

Where It Misleads

The commonest error is using it for an arthritic knee, where its items do not cover the burden. 4.22.5 covers the Oxford Knee Score.

Its scores are compared with another instrument's. 4.22.2 covers the KOOS.

The clinician assessed items are completed by the clinician and the result is reported as patient reported. 4.1.8 covers examination documentation.

A high score is read as readiness for sport. 4.21.7 covers return to sport testing.

An incomplete questionnaire is scored. 4.22.8 covers the use of these scores.

Fellowship Level

Where It Misleads

At fellowship level this instrument's problems are the ones its age predicts.

Its items reflect the activities and the expectations of the period it was written in, which affects how a current patient answers them. 4.22.8 covers the use of these scores.

It mixes patient reported and clinician assessed items, so the score is not a pure patient reported measure despite being used as one. 4.1.8 covers examination documentation.

Ceiling effects in an active population are more marked here than in the instruments with a sport domain. 4.22.2 covers the KOOS.

Its continued use rests on comparability, which is a reason to keep collecting it alongside a modern instrument rather than instead of one. 4.22.1 covers the IKDC.

Its psychometric properties are published quantities this repository does not state, so no claim about them is made here. 4.2.10 covers severity.

No item count, score range or validation figure appears on this page. Those are properties of a published instrument and stating one from memory is the same class of claim as an invented citation, so the page describes what the instrument does and a reviewer with the questionnaire can add the numbers.