I've previously posted about the single leg hop test and its role in the decision-making process regearding return to sport following lower limb injury. Now, I'll cover the 4 hop test battery that is commonly used in return to sport testing following ACL surgery (SEE picture above).
2 recent studies (Kyritsis et al., 2016 & Grindem et al, 2016) show that athletes were significantly more likely to sustain a 2nd ACL injury when all discharge criteria were NOT met; which included the 4 following hop tests:
- single hop (>10% difference between limbs),
- triple hop (>10% difference between limbs),
- triple crossover hop (>10% difference between limbs),
- 6m timed hop (>10% difference between limb limbs)
*NB: Other discharge criteria included isokinetic quads & hamstring strength testing, agility T-Test and completing sport-specific conditioning and training.
Further to these 2 studies, another recent trial showed that performing these 4 hop tests of the uninvolved limb in patients awaiting ACL surgery (PRE-OP) is superior to predicting 2nd ACL injuries than strength & hop tests at >6 months POST-OP (Wellsandt et al, 2017).
Take home messages:
1) If you're not using functional tests such as hop tests in the return to sport decision making process for ACLR patients, you need to start ASAP. It really should be considered a non-negotiable for both athlete and treating physio. It takes the guessing game out of the equation, and objectively shows functional deficits between limbs. They're not 100% perfect, but it certainly is better than allowing your patient to return to sport because it's been 12 months since their op.
2) PRE-OP physio is NOT A WASTE OF TIME. Getting strong and establishing baseline measures when the patient/athlete is at their fittest (and strongest), appears to be more accurate in determining readiness to return to sport, than testing the patient/athlete >6 months post-op when they've deconditioned following surgery.