Muscle, joint & pain

The Tegner Scale: Rating Your Activity Level

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A knee that hurts on stairs and a knee that fails on a cutting turn are not the same problem, even at the same symptom score. Tegner and Lysholm built this activity ladder in 1985 as the companion to their symptom scale, so that results could be compared between people who genuinely demand the same things of their knees.

Last updated: July 2026

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What the Tegner Activity Scale is

It is one item. You are not asked how the knee feels, whether it swells, or how far you can walk. You are asked to place the level of work and sport you currently do on a graded ladder, an eleven-level gradient scored from 0 to 10, where a higher number means a more demanding activity level 1. The rung descriptions are printed on the form itself.

Tegner and Lysholm published it in 1985 as a deliberate complement to symptom-based functional scoring in the evaluation of knee ligament injuries — not a replacement for it, but the second axis those scores were missing 1. Every other knee measure asks what the knee can do. This one asks what is being asked of the knee.

Because a single Tegner number is difficult to interpret without knowing where a person started, you may be asked for two: the level you were at before the injury, and the level you are at now.

Why an activity rating exists at all

Because a symptom score can be flattered by avoidance. The Lysholm Knee Scoring Scale, published three years earlier, was designed for knee ligament surgery follow-up with particular emphasis on symptoms of instability — the knee giving way during activity. Validated against a modified Larson scale, it produced significantly lower totals in unstable knees and tracked both the patient's own opinion of function and the clinical signs of instability 2.

It runs from 0 to 100, and higher means better function 2. But giving way during activity hides a variable. A knee that never gives way because its owner quit soccer and now walks the dog will score well. The same knee, in someone still playing on Sundays, scores badly. Read off the paper alone, those two knees are indistinguishable, and they are not the same knee.

That is the gap the 1985 activity grading was built to close: record the demand alongside the symptoms, and the symptom score becomes interpretable 1.

What the number encodes, and what it leaves out

It encodes demand, not capacity. Your Tegner level describes what you currently do. It does not say what you could do, how much it hurts while you do it, or what the joint looks like on imaging. Someone can fall several levels with a knee that examines normally, and someone else can hold their level with a knee full of arthritis.

This is why the scale is never read alone. Pain is a separate quantity with separate instruments — a numeric pain rating scale or a visual analog scale exists precisely because pain does not fall out of an activity level. Fear is separate again, which is what a measure like the tampa scale of kinesiophobia is for.

A person who is physically ready to return and a person whose knee genuinely cannot take it can be sitting on the same rung. The activity number tells you they are on that rung. It cannot tell you why.

Does a change in Tegner level mean anything?

Not by any threshold the original paper supplies. The 1985 publication is a scale-development paper — it introduces the activity grading and states its purpose — and it puts no change threshold on record: neither a minimal detectable change nor a minimal clinically important difference appears in it 1. It predates the conventions that made those statistics standard.

Change thresholds you see attached to the Tegner scale come from later validation work and belong to that work, not to the original. Some knee instruments do carry the number. The IKDC Subjective Knee Form, validated by administering it to 533 patients with a variety of knee problems, reports a minimal detectable change of 9.0 points 3, alongside internal consistency of 0.92 and test-retest reliability of 0.95 3. Its factor analysis found a single dominant component, which is what justifies combining its questions into one score at all, and it showed no meaningful differential item function by age, sex, or diagnosis 3.

So a one-rung move on an eleven-level activity ladder is not the same kind of fact as a nine-point move on a validated hundred-point scale. It should not be read as though it were.

Where the Tegner sits among the other knee scores

It is the demand axis in a set of measures that otherwise describe the knee itself. The KOOS spreads across five subscales — pain, symptoms, daily living, sport and recreation, and knee-related quality of life — a deliberately wide net over what a knee injury actually costs a person 4. The Lysholm scale concentrates on instability symptoms 2. The IKDC combines symptoms, function, and sports activity into a single knee-specific score 3.

Other measures approach from other angles. A leg-function questionnaire such as the lower extremity functional scale asks about everyday tasks rather than sport. The patient-specific functional scale inverts the design entirely, asking the person to nominate the activities that matter to them instead of working from a fixed list. None of this is knee-specific thinking, either — the quebec back pain disability scale carries the same task-based idea into back pain.

The Tegner does none of that. It steps back from the knee and asks what league you are playing in — which is information none of the others contain.

Why an ACL clinic asks for your activity level on day one

Because the decision in front of you depends on it. ACL injuries are common in cutting and pivoting sports, and the choice between reconstruction and nonsurgical rehabilitation turns on activity demands and on what else was injured at the same time 5. That is not a hedge, it is the decision rule.

A knee that must cut and pivot under load is being asked a different question than a knee that carries someone through a flat workday, and a torn ligament alongside a meniscus tear is a different problem than a torn ligament alone.

The same logic runs through rehabilitation. The physical-therapy guideline for knee ligament sprains recommends progressive exercise and criteria-based return to activity 6 — criteria-based meaning you advance when you meet a standard, not when a date on the calendar arrives. What the standard has to be is set by what you are returning to. So the number describing what you are returning to gets recorded at the start, before anyone knows how the story ends.

What the scale cannot do

It cannot grade a knee, and it decides nothing by itself. An activity ladder compresses a life of movement into one integer, which is coarse by design: it was built for comparability across patients and studies, not for a rich description of any one person. Two people sitting at the same level can be living very different weeks.

It also cannot tell you whether the level you are on is the right one. Moving down the ladder is sometimes a sensible adaptation to a body at fifty and sometimes an avoidable loss at twenty-five, and the integer is identical either way. Whether a lower level means a knee that cannot do more or a person who has stopped asking it to is a conversation, not a calculation — and starting that conversation is roughly what the scale is for.

A Tegner level describes this month. It is not a prediction about next year, and it is not a ceiling.

Common questions

Each rung on the ladder carries a written description of a work or sport activity, and those descriptions are printed on the form your clinic gives you. The gradient covers eleven levels from 0 to 10, and higher always means a more demanding activity level. The scale grades work and sport specifically, not general fitness or how far you can walk.

Higher means more demanding activity, which is not automatically better. The scale measures what you do, not how well your knee works. A high level in someone whose knee gives way weekly is a warning rather than a success, and a modest level in someone who never wanted to play sport is not a deficit at all.

The original paper publishes no target, no cutoff, and no threshold for success. The comparison that carries meaning is your own: the level you were at before the injury against the level you are at now. A surgeon or therapist will read that gap alongside your symptoms and your examination, never as a standalone verdict.

No, though they share an author and are usually reported together. The Lysholm scale is a symptom score emphasizing instability, running from 0 to 100 with higher meaning better function. The Tegner is a single-item activity rating from 0 to 10. Tegner and Lysholm designed the activity scale in 1985 specifically as a complement to that symptom scoring.

The number is only useful if it describes what you are genuinely doing now, not what you intend to do next month. An inflated level makes a recovering knee look worse than it is, and a deflated one hides a knee that is being pushed. Clinicians read the gap between your pre-injury and current levels; both need to be honest for the gap to mean anything.

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When a knee needs to be seen rather than scored

  • —A knee that buckles or gives way on flat ground, not only during sport
  • —A knee locked in a bent position that will not fully straighten
  • —A knee that becomes hot and swollen with fever or a general feeling of illness
  • —A knee that swells rapidly within a couple of hours of a twisting injury, or that will not take any weight at all

A hot, swollen knee with a fever can mean joint infection, and a knee that cannot bear any weight after an injury needs imaging. Both are same-day problems — urgent care or an emergency department, not a wait for a routine appointment.

This article is general education about an outcome measure, not medical advice. An activity level describes what you currently do; only a clinician who can examine your knee is in a position to say what it is safe to ask of it.

References

  1. 1.Tegner Y, Lysholm J. (1985). Rating systems in the evaluation of knee ligament injuries. Clinical Orthopaedics and Related Research, September 1985, issue 198, pages 43-49. doi:10.1097/00003086-198509000-00007 ✓The Tegner Activity Scale's origin, purpose, and construction: a single-item grading of work and sport activity on an eleven-level gradient scored 0-10, higher denoting higher activity, developed as a complement to symptom-based functional scoring in the evaluation of knee ligament injuries; and that this scale-development paper reports no MCID and no MDC.
  2. 2.Lysholm J, Gillquist J. (1982). Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. The American Journal of Sports Medicine, 10(3):150-154. doi:10.1177/036354658201000306 ✓The Lysholm Knee Scoring Scale's origin and purpose — designed for knee ligament surgery follow-up with emphasis on symptoms of instability (giving way during activity) — its 0-100 scoring with higher indicating better function, and its original validation against a modified Larson scale, including lower totals in unstable knees and correspondence with the patient's own opinion of function and clinical instability signs.
  3. 3.Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001). Development and Validation of the International Knee Documentation Committee Subjective Knee Form. The American Journal of Sports Medicine, 29(5), 600–613. doi:10.1177/03635465010290051301 ✓The IKDC Subjective Knee Form as a knee-specific measure of symptoms, function, and sports activity validated in 533 patients; its internal consistency of 0.92 and test-retest reliability of 0.95; its minimal detectable change of 9.0 points; its unidimensionality on factor analysis justifying a single combined score; and the absence of meaningful differential item function by age, sex, or diagnosis.
  4. 4.Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998). Knee Injury and Osteoarthritis Outcome Score (KOOS)—Development of a Self-Administered Outcome Measure. Journal of Orthopaedic & Sports Physical Therapy. doi:10.2519/jospt.1998.28.2.88The KOOS as a validated patient-reported outcome measure for knee injury and osteoarthritis with five subscales: pain, symptoms, activities of daily living, sport and recreation, and knee-related quality of life.
  5. 5.American Academy of Orthopaedic Surgeons (OrthoInfo) (2024). Anterior Cruciate Ligament (ACL) Injuries. OrthoInfo — AAOS. link ✓That ACL injuries are common in cutting and pivoting sports, and that the choice between reconstruction and nonsurgical rehabilitation depends on activity demands and associated injuries.
  6. 6.Logerstedt DS, Scalzitti D, Risberg MA, et al. (2017). Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017. Journal of Orthopaedic & Sports Physical Therapy. doi:10.2519/jospt.2017.0303The APTA/JOSPT knee ligament sprain guideline's rehabilitation recommendations, including progressive exercise and criteria-based return to activity.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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