Is It Time We Better Understood the Tests We are Using for Return to Sport Decision Making Following ACL Reconstruction? A Critical Review of the Hop Tests

William T Davies, Gregory D Myer, Paul J Read, William T Davies, Gregory D Myer, Paul J Read

Abstract

There has been a move towards a criterion-based return to play in recent years, with 4 single-leg hop tests commonly used to assess functional performance. Despite their widespread integration, research indicates that relationships between 'passing' 'hop test criteria and successful outcomes following rehabilitation are equivocal, and, therefore, require further investigation. This critical review includes key information to examine the evolution of these tests, their reliability, relationships with other constructs, and sensitivity to change over time. Recommendations for how measurement and administration of the tests can be improved are also discussed. The evidence presented in this review shows that hop tests display good reliability and are sensitive to change over time. However, the use of more than 2 hop tests does not appear to be necessary due to high collinearity and no greater sensitivity to detect abnormality. The inclusion of other hop tests in different planes may give greater information about the current function of the knee, particularly when measured over time using both relative and absolute measures of performance. It is recommended that the contralateral limb be tested prior to surgery for a more relevant benchmark for performance, and clinicians are strongly advised to measure movement quality, as hop distance alone appears to overestimate the recovery of the knee.

Conflict of interest statement

Will Davies, Gregory Myer, and Paul Read declare that they have no conflicts of interest relevant to the content of this review.

Figures

Fig. 1
Fig. 1
Criteria most used as part of the return to sport decision (data extracted from Burgi et al. [8]). SHD single hop for distance, THD triple hop for distance, CHD cross-over hop for distance, 6TH 6 m timed hop
Fig. 2
Fig. 2
Depiction of the 4 single leg hop tests commonly used in return to sport protocols: a single hop for distance, b triple hop for distance, c cross-over hop for distance, d 6-m timed hop
Fig. 3
Fig. 3
Changing limb symmetry index as a percentage over time from surgery. To avoid rehabiltation protocol bias, only studies that measured all 4 hops longitudinally were selected. Pre-op [66], 12 weeks [38, 63], 26 weeks [38, 63, 66], and 52 weeks [63, 66] (Reid et al. [38] data were taken at 16 and 22 weeks, and have been included as part of the analysis at 12 and 26 weeks, respectively). SHD single hop for distance, THD triple hop for distance, CHD cross-over hop for distance, TH6 6 m timed hop, LSI limb symmetry index

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