Tegner Activity Scale: documenting return to sport after knee surgery
Complete Tegner Activity Scale guide — 11 activity levels (0–10), return-to-sport criteria and combined use with the Lysholm score.
What is the Tegner Activity Scale?
The Tegner Activity Scale was developed by Tegner and Lysholm (1985) as a complement to the Lysholm Knee Score. It is an ordinal scale from 0 to 10 that quantifies the patient's level of physical and sporting activity — not knee function itself, but what the patient is able to do.
Its main application is documenting return to sport after knee surgery, recording the pre-injury activity level and the current post-treatment level, and calculating the delta between the two timepoints.
Record two scores: the pre-injury activity level and the current level. The delta indicates the degree of return to activity. A persistent negative delta indicates residual functional limitation.
The 11 activity levels (0–10)
| Level | Activity |
|---|---|
| 10 | Competitive football — national/international level |
| 9 | Competitive football — lower divisions; ice hockey |
| 8 | Competitive badminton, basketball, squash |
| 7 | Competitive tennis, athletics, motocross |
| 6 | Recreation: tennis, badminton, squash, running ≥ 5×/week |
| 5 | Heavy work; cycling, running ≥ 2×/week |
| 4 | Moderate work; cycling, cross-country skiing |
| 3 | Light work; walking on uneven ground |
| 2 | Light work; walking on even ground |
| 1 | Sedentary work, no recreational activity |
| 0 | Sick leave or disability due to knee problems |
Calculate the TEGNER for free
Apply the questionnaire online and get the score with exportable PDF.
Clinical application and scientific publication
The Tegner scale is mandatory in virtually all knee surgery studies published in high-impact journals. ISAKOS guidelines recommend applying it together with the IKDC for complete characterisation of functional outcome.
| Criterion | Reference value |
|---|---|
| Return to recreational sport | Tegner ≥ 6 |
| Return to competitive sport | Tegner ≥ 7 |
| Return to competitive football | Tegner ≥ 9 |
| Full return to pre-injury level | Delta = 0 |
Reliability and limitations
The Tegner scale has good test-retest reliability (ICC > 0.80) and adequate construct validity when compared with objective measures of function (Briggs et al., 2009).
Main limitation: it is an ordinal scale with unequal intervals between levels. A patient who moves from level 4 to 5 has not necessarily improved in the same proportion as one who moves from 7 to 8. Consider this in advanced statistical analyses.
References
- 1. Tegner Y, Lysholm J. “Rating systems in the evaluation of knee ligament injuries.” Clin Orthop Relat Res, 1985;(198):43–9.
- 2. Briggs KK, Lysholm J, Tegner Y, et al. “The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries.” Am J Sports Med, 2009;37(5):890–7.