Jack Lysholm

Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale

We have designed a scoring scale for knee ligament surgery follow-up emphasizing evaluation of symp toms of instability. Instability is defined as giving way during activity. Our scoring scale was compared to a slightly modified Larson scale in patients with anteromedial and/or anterolateral instability, poster olateral and straight posterior instability, chondroma lacia patellae, and meniscus lesion. The two scales gave basically the same results in patients with menis cus rupture. In patients with unstable knees, the new scale gave a significantly lower total score. Thus, the new scale evaluates functional impairment due to clin ical instability better than the modified Larson scale. The total score, with the new scoring scale, corre sponded to the patients own opinion of function and to the presence or absence of signs of instability.

The Reliability, Validity, and Responsiveness of the Lysholm Score and Tegner Activity Scale for Anterior Cruciate Ligament Injuries of the Knee 25 Years Later

Background In 1982, the Lysholm score was first published as a physician-administered score in the American Journal of Sports Medicine. The Tegner activity scale was published in 1985. Hypothesis The Lysholm and Tegner scores are valid as patient-administered scores and responsive at early time points after treatment of anterior cruciate ligament tears. Study Design Cohort study (Diagnosis); Level of evidence, 1. Methods All patients were treated for an anterior cruciate ligament tear. For responsiveness, the Lysholm score (n = 1075) and Tegner activity level (n = 505) were measured preoperatively and 6, 9, 12, and 24 months postoperatively. For test-retest (n = 50), scores were measured at 2 years postoperatively and again within 4 weeks by questionnaire. For criterion validity (n = 170), patients completed the Short Form-12 and the International Knee Documentation Committee score in addition to Lysholm and Tegner instruments. For all other analyses, preoperative Lysholm score (n = 1783) or Tegner activity levels (n = 687) were collected. Results There was acceptable test-retest reliability for both the Lysholm (intraclass correlation coefficient = 0.9) and Tegner (intraclass correlation coefficient = 0.8) scores. The minimum detectable change for Lysholm was 8.9 and for Tegner was 1. The Lysholm demonstrated acceptable internal consistency. The Lysholm correlated with the International Knee Documentation Committee (r = .8) and the Short Form-12 (r = .4), and Tegner correlated with the Short Form-12 (r = .2). Both scores had acceptable floor and ceiling effects and all hypotheses were significant. The Lysholm and Tegner were responsive to change at each of the time points. Conclusion After 25 years of changes in treatment of anterior cruciate ligament injuries, the Lysholm knee score and the Tegner activity scale demonstrated acceptable psychometric parameters as patient-administered scores and showed acceptable responsiveness to be used in early return to function after anterior cruciate ligament treatment.

The effect of diagnostic and operative arthroscopy and open meniscectomy on muscle strength in the thigh

In this study we measured the effect on the muscle strength in the thigh in connection with diagnostic ar throscopy with central approach, arthroscopy with ar throscopic operation of bucket-handle ruptures, flap tears, total arthroscopic meniscectomy, and open men iscectomy. Thirty-seven patients were tested preoper atively and 1, 4 and 8 weeks postoperatively with a Cybex ll isokinetic dynamometer. The extensor mus cles of the knee joint were most affected. The flexor muscles were generally recovered in all groups within a month. Diagnostic arthroscopy and arthroscopic op erations for bucket-handle ruptures showed no signifi cant effect on the thigh muscle torque. With the other arthroscopic operations there was a 40% decrease of quadriceps function 1 week after operation. After 8 weeks normal function returned. Open meniscectomy had a much more negative effect on the quadriceps muscle with a decrease of about 70% after 1 week. After 8 weeks, the rehabilitation was still not complete.

Evaluation of Knee Ligament Injuries

Our target when treating patients with knee ligament injuries should be to restore knee function. This could mean operative or conservative therapy. To measure whether we have succeeded in our aims or not, we need an evaluation system that measures knee function. The system needs to be reproducible and objective, so that comparisons between different treatments are possible.

Is the rehabilitation after knee ligament surgery effective enough

Rehabilitation after knee ligament surgery is long and demanding. Many studies suggest that several patients never resume normal muscle function in the operated leg.