Translation, Cultural Adaptation, and Validation of the Persian Lysholm Knee Scale in Iran
-
Jalal Ahadi
,
Hakimeh Adigozali
,
Bahram Amirshakeri
,
Parvin Sarbakhsh
,
Sargol Pirinejad
,
Fatemeh Fekar Gharamaleki
Abstract
Background: Valid and culturally adapted patient-reported tools are essential for accurate clinical assessment of knee injury outcomes. This study aimed to translate the English Lysholm Knee Scoring Scale (LKSS) into Persian and comprehensively validate it.
Methods: This methodological study (test development) employed a cross-sectional design. The LKSS was translated using Guillemin's standard method. Validity and reliability were assessed in a sample of 182 patients with knee injuries. We evaluated content validity (Content Validity Ratio (CVR) and Content Validity Index (CVI)), face validity (impact score), convergent validity (correlation with the International Knee Documentation Committee (IKDC) form), construct validity (Exploratory Factor Analysis (EFA)), and reliability, including internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient (ICC)), and Standard Error of Measurement (SEM).
Results: All items demonstrated acceptable content validity (CVR >0.79 and CVI >0.62). All face validity impact scores were above the 1.5 threshold. Convergent validity was excellent, with a very high correlation between the LKSS and IKDC (r=0.804, p<0.001). The EFA supported a one-factor structure (KMO=0.829; Bartlett's test p<0.001), explaining 42.39% of the variance. Reliability was outstanding, with an ICC of 0.95, a Cronbach's alpha of 0.894, and an SEM of 5.14.
Conclusion: The Persian LKSS demonstrated high validity and reliability across all measured metrics. These results confirm it is a psychometrically sound and suitable instrument for assessing knee-related function and outcomes in the Iranian population, suitable for both clinical and research applications.
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2. Peccin MS, Ciconelli R, Cohen M. Specific questionnaire for knee symptoms-the "Lysholm Knee Scoring Scale": translation and validation into Portuguese. Acta Ortop Bras. 2006;14(5):268-72.
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5. Wright RW. Knee injury outcomes measures. J Am Acad Orthop Surg. 2009;17(1):31-9.
6. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10(3):150-4. doi:10.1177/036354658201000306
7. Wang W, Liu L, Chang X, Jia Z, Zhao J, Xu W. Cross-cultural translation of the Lysholm knee score in Chinese and its validation in patients with anterior cruciate ligament injury. BMC Musculoskelet Disord. 2016;17:436. doi:10.1186/s12891-016-1286-2
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10. Panagopoulos A, Billis E, Floros GR, Stavropoulos T, Kaparounaki E, Moucho M, et al. Cross-cultural adaptation of the Greek versions of the Lysholm knee scoring scale and Tegner activity scale. Cureus. 2020;12(7):e9322. doi:10.7759/cureus.9322
11. Eshuis R, Lentjes GW, Tegner Y, Wolterbeek N, Veen MR. Dutch translation and cross-cultural adaptation of the Lysholm score and Tegner activity scale for patients with anterior cruciate ligament injuries. J Orthop Sports Phys Ther. 2016;46(11):976-83. doi:10.2519/jospt.2016.6566
12. Wirth B, Liffert F, De Bruin ED. Development and evaluation of a German version of the Lysholm score for measuring outcome after anterior cruciate ligament injuries. Sportverletz Sportschaden. 2011;25(1):37-43. doi:10.1055/s-0029-1245812
13. Deviandri R, van der Veen HC, Lubis AM, Postma MJ, van den Akker-Scheek I. Translation and psychometric analysis of the Indonesian versions of the Lysholm and Tegner Scores for patients with anterior cruciate ligament injuries. Orthop J Sports Med. 2022;10(1):23259671211066506. doi:10.1177/23259671211066506
14. Cerciello S, Corona K, Morris BJ, Visonà E, Maccauro G, Maffulli N, et al. Cross-cultural adaptation and validation of the Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scores in patients with patellofemoral disorders. J Orthop Traumatol. 2018;19(1):18. doi:10.1186/s10195-018-0515-x
15. Itthipanichpong T, Moonwong S, Thamrongskulsiri N, Prasathaporn N, Kuptniratsaikul S, Tegner Y, et al. Validity and reliability of the Thai versions of the Lysholm knee scoring scale and Tegner activity scale. Orthop J Sports Med. 2023;11(2):23259671221149785. doi:10.1177/23259671221149785
16. Sharif F, Ahmad A, Gilani S, Bacha R, Hanif A, Ahmed S. Translation, cross-cultural adaptation and psychometric properties of the Urdu version of Lysholm knee score for Pakistani population. Muscles Ligaments Tendons J. 2022;12(1):35-42. doi:10.32098/mltj.01.2022.05
17. Ahmed KM, Said HG, Ramadan EKA, Abd El-Radi M, El-Assal MA. Arabic translation and validation of three knee scores, Lysholm knee score (LKS), Oxford knee score (OKS), and International knee documentation committee subjective knee form (IKDC). SICOT J. 2019;5:6. doi:10.1051/sicotj/2019002
18. Vosoughi F, Movahed A, Azimi A, Salehian M, Karimi A, Omidi M, et al. Psychometric Validation of the Persian Version of the Lysholm Score. Orthop J Sports Med. 2025;13(4):23259671251327682.
19. Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med. 2006;119(2):166.e7-16. doi:10.1016/j.amjmed.2005.10.036
20. Akoglu H. User's guide to correlation coefficients. Turk J Emerg Med. 2018;18(3):91-3. doi:10.1016/j.tjem.2018.08.001
21. Mallery P, George D. SPSS for windows step by step. Boston: Allyn & Bacon; 2000.
22. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155-63. doi:10.1016/j.jcm.2016.02.012
23. Pallant J. SPSS survival manual: a step by step guide to data analysis using IBM SPSS. 7th ed. London: Routledge; 2020.
24. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737-45. doi:10.1016/j.jclinepi.2010.02.006
25. Fekar Gharamaleki F, Fathipour-Azar Z. Cross-cultural adaptation and validation of cognitive emotion regulation questionnaire: a systematic review. Front Psychol. 2025;15:1494665. doi:10.3389/fpsyg.2024.1494665
26. Amirshakeri B, Khalkhali Zavieh M, Rezaei M, Adigozali H. Measuring the force perception in knee flexor/extensor muscles in patients with anterior cruciate ligament injury and healthy subjects. J Back Musculoskelet Rehabil. 2022;35(1):103-10. doi:10.3233/BMR-210008
27. Gharamaleki FF, Fathipour-Azar Z. Voice Related Quality of Life Questionnaire (V-RQOL): cross-cultural adaptation, validity, and reliability of the Azerbaijani-Turkish version. J Voice. 2024;S0892-1997(24)00320-4. doi:10.1016/j.jvoice.2024.10.005
28. Zhoolideh P, Ghaderi F, Salahzadeh Z, Adigozali H, Azghani MR, Jafarabadi MA, et al. The relationship between static standing posture and common pelvic floor disorders. Muscle Ligaments Tendons J. 2021;11(1):77-83. doi:10.32098/mltj.01.2021.09
29. Mahmoudzadeh T, Ghaderi F, Jafarabadi MA, Sepehri B, Adigozali H. Validity and Reliability of the Persian Version of the Comprehensive Constipation Questionnaire: A Cross-Sectional Study. J Mod Rehabil. 2023;17(3):151-61. doi:10.32598/JMR.17.3.1005487.1
30. Mazidluie MH, Ahadi J, Eslami FO, Ghanavati T, Moradi A. Comparison of the effects of cognitive dual-task and single-task balance exercises on static balance among people with anterior cruciate ligament reconstruction: A randomized controlled trial. Arch Bone Jt Surg. 2024;12(5):349-56. doi:10.22038/ABJS.2024.75413.3498
31. Fathipour-Azar Z, Masumi J, Gharamaleki FF, Ery M, Mousavi E. Optimization of Transcranial Direct Current Stimulation Protocols for Enhancing Cognitive Function in Healthy Older Adults: A Systematic Review. Middle East J Rehabil Health Stud. 2026;13(1):e165826. doi:10.5812/mejrh-165826
2. Peccin MS, Ciconelli R, Cohen M. Specific questionnaire for knee symptoms-the "Lysholm Knee Scoring Scale": translation and validation into Portuguese. Acta Ortop Bras. 2006;14(5):268-72.
3. Eslami FO, Ahadi J, Mazidluie MH, Ghanavati T, Moradi A. Comparative Analysis of Dual-Task and Single-Task Balance Exercises in Improving Static Balance in Individuals with Anterior Cruciate Ligament Reconstruction. J Mod Rehabil. 2024;18(1):18-27. doi:10.32598/JMR.18.1.2175.1
4. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S208-S28. doi:10.1002/acr.20632
5. Wright RW. Knee injury outcomes measures. J Am Acad Orthop Surg. 2009;17(1):31-9.
6. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10(3):150-4. doi:10.1177/036354658201000306
7. Wang W, Liu L, Chang X, Jia Z, Zhao J, Xu W. Cross-cultural translation of the Lysholm knee score in Chinese and its validation in patients with anterior cruciate ligament injury. BMC Musculoskelet Disord. 2016;17:436. doi:10.1186/s12891-016-1286-2
8. Arroyo-Morales M, Martin-Alguacil JL, Lozano-Lozano M, Cuesta-Vargas AI, Fernández-Fernández AJ, González JA, et al. The Lysholm score: cross cultural validation and evaluation of psychometric properties of the Spanish version. PLoS One. 2019;14(8):e0221376. doi:10.1371/journal.pone.0221376
9. Celik D, Coskunsu D, Kiliçoglu Ö. Translation and cultural adaptation of the Turkish Lysholm knee scale: ease of use, validity, and reliability. Clin Orthop Relat Res. 2013;471(8):2602-10. doi:10.1007/s11999-013-3044-1
10. Panagopoulos A, Billis E, Floros GR, Stavropoulos T, Kaparounaki E, Moucho M, et al. Cross-cultural adaptation of the Greek versions of the Lysholm knee scoring scale and Tegner activity scale. Cureus. 2020;12(7):e9322. doi:10.7759/cureus.9322
11. Eshuis R, Lentjes GW, Tegner Y, Wolterbeek N, Veen MR. Dutch translation and cross-cultural adaptation of the Lysholm score and Tegner activity scale for patients with anterior cruciate ligament injuries. J Orthop Sports Phys Ther. 2016;46(11):976-83. doi:10.2519/jospt.2016.6566
12. Wirth B, Liffert F, De Bruin ED. Development and evaluation of a German version of the Lysholm score for measuring outcome after anterior cruciate ligament injuries. Sportverletz Sportschaden. 2011;25(1):37-43. doi:10.1055/s-0029-1245812
13. Deviandri R, van der Veen HC, Lubis AM, Postma MJ, van den Akker-Scheek I. Translation and psychometric analysis of the Indonesian versions of the Lysholm and Tegner Scores for patients with anterior cruciate ligament injuries. Orthop J Sports Med. 2022;10(1):23259671211066506. doi:10.1177/23259671211066506
14. Cerciello S, Corona K, Morris BJ, Visonà E, Maccauro G, Maffulli N, et al. Cross-cultural adaptation and validation of the Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scores in patients with patellofemoral disorders. J Orthop Traumatol. 2018;19(1):18. doi:10.1186/s10195-018-0515-x
15. Itthipanichpong T, Moonwong S, Thamrongskulsiri N, Prasathaporn N, Kuptniratsaikul S, Tegner Y, et al. Validity and reliability of the Thai versions of the Lysholm knee scoring scale and Tegner activity scale. Orthop J Sports Med. 2023;11(2):23259671221149785. doi:10.1177/23259671221149785
16. Sharif F, Ahmad A, Gilani S, Bacha R, Hanif A, Ahmed S. Translation, cross-cultural adaptation and psychometric properties of the Urdu version of Lysholm knee score for Pakistani population. Muscles Ligaments Tendons J. 2022;12(1):35-42. doi:10.32098/mltj.01.2022.05
17. Ahmed KM, Said HG, Ramadan EKA, Abd El-Radi M, El-Assal MA. Arabic translation and validation of three knee scores, Lysholm knee score (LKS), Oxford knee score (OKS), and International knee documentation committee subjective knee form (IKDC). SICOT J. 2019;5:6. doi:10.1051/sicotj/2019002
18. Vosoughi F, Movahed A, Azimi A, Salehian M, Karimi A, Omidi M, et al. Psychometric Validation of the Persian Version of the Lysholm Score. Orthop J Sports Med. 2025;13(4):23259671251327682.
19. Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med. 2006;119(2):166.e7-16. doi:10.1016/j.amjmed.2005.10.036
20. Akoglu H. User's guide to correlation coefficients. Turk J Emerg Med. 2018;18(3):91-3. doi:10.1016/j.tjem.2018.08.001
21. Mallery P, George D. SPSS for windows step by step. Boston: Allyn & Bacon; 2000.
22. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155-63. doi:10.1016/j.jcm.2016.02.012
23. Pallant J. SPSS survival manual: a step by step guide to data analysis using IBM SPSS. 7th ed. London: Routledge; 2020.
24. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737-45. doi:10.1016/j.jclinepi.2010.02.006
25. Fekar Gharamaleki F, Fathipour-Azar Z. Cross-cultural adaptation and validation of cognitive emotion regulation questionnaire: a systematic review. Front Psychol. 2025;15:1494665. doi:10.3389/fpsyg.2024.1494665
26. Amirshakeri B, Khalkhali Zavieh M, Rezaei M, Adigozali H. Measuring the force perception in knee flexor/extensor muscles in patients with anterior cruciate ligament injury and healthy subjects. J Back Musculoskelet Rehabil. 2022;35(1):103-10. doi:10.3233/BMR-210008
27. Gharamaleki FF, Fathipour-Azar Z. Voice Related Quality of Life Questionnaire (V-RQOL): cross-cultural adaptation, validity, and reliability of the Azerbaijani-Turkish version. J Voice. 2024;S0892-1997(24)00320-4. doi:10.1016/j.jvoice.2024.10.005
28. Zhoolideh P, Ghaderi F, Salahzadeh Z, Adigozali H, Azghani MR, Jafarabadi MA, et al. The relationship between static standing posture and common pelvic floor disorders. Muscle Ligaments Tendons J. 2021;11(1):77-83. doi:10.32098/mltj.01.2021.09
29. Mahmoudzadeh T, Ghaderi F, Jafarabadi MA, Sepehri B, Adigozali H. Validity and Reliability of the Persian Version of the Comprehensive Constipation Questionnaire: A Cross-Sectional Study. J Mod Rehabil. 2023;17(3):151-61. doi:10.32598/JMR.17.3.1005487.1
30. Mazidluie MH, Ahadi J, Eslami FO, Ghanavati T, Moradi A. Comparison of the effects of cognitive dual-task and single-task balance exercises on static balance among people with anterior cruciate ligament reconstruction: A randomized controlled trial. Arch Bone Jt Surg. 2024;12(5):349-56. doi:10.22038/ABJS.2024.75413.3498
31. Fathipour-Azar Z, Masumi J, Gharamaleki FF, Ery M, Mousavi E. Optimization of Transcranial Direct Current Stimulation Protocols for Enhancing Cognitive Function in Healthy Older Adults: A Systematic Review. Middle East J Rehabil Health Stud. 2026;13(1):e165826. doi:10.5812/mejrh-165826
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Knee injuries; Patient reported outcome measures; Translating; Iran; Questionnaire | ||
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How to Cite
1.
Ahadi J, Adigozali H, Amirshakeri B, Sarbakhsh P, Pirinejad S, Fekar Gharamaleki F. Translation, Cultural Adaptation, and Validation of the Persian Lysholm Knee Scale in Iran. jmr. 2026;(-).
