What Is The ACL Return To Sport Testing?

The ACL return to sport testing is a battery of tests. Doctors and therapists created the tests to ensure that an athlete is safe to return to their sport. We look at proper form, strength and symmetry of the legs in order to make the decision: pass or fail.

A typical return to sport battery of tests post ACL repair has many components.

The 4 Hop tests

The tests allow for one practice trial and then 2 additional jumps on each leg. For each jump we measure the distance covered. The therapist will record the distance and compare it between the two legs.The test assesses how much control and stability you have over your knee and body and if you can stick each landing for at least 2 seconds.

The first test, the single hop test is a single jump and land on one leg. The triple hop test requires you to complete three jumps in a row on one leg and stick the landing on the last one. The third test is a triple hop crossover test for distance. The test requires you to add a lateral component to the three hops, with each hop the test requires you to cross over a line. This test adds a side to side component and challenges your stability. Lastly, the timed 6 meter hop test. This test requites you to cover the distance of 6 meters jumping on one leg as fast as possible. Check out this is link for a good visual of the 4 tests.

The Drop Box Test

The test asks you to jump down to the ground and land on two feet from a 10 inch height. The therapist will observe and record quality of movement.

The LSI (Limb Symmetry Index)

Your therapist with measure the distance and time from the hop testing above and give you a score. Most doctors and therapists agree that the distance covered with each leg should be nearly the same or at least within 90% of one another. This means if you can jump 12 inches on your non-surgical leg, you should be able to jump nearly the same distance with your surgical leg. We like to draw the comparison between the two legs for all 4 hop tests.

IKDC 9 (International Knee Documentation Committee)

The IKDC is a written questionnaire that assesses your mental readiness to return to sport. There you will see questions regarding various activities and how much confidence you have in your surgical knee.

Symmetrical running, jogging and walking patterns

The therapist will look for equal time spent on each leg, aka stance time. Additionally, they will look for  equal length steps also known as stride length. This can be completed with verbal feedback, visual feedback such as Hudl or sensor analysis such as Dorsa Vi.

Please check out the British Journal of Sports Medicine for the clinical practice guidelines for the ACL Rehab. But, you have to promise to imagine the sophisticated British accent as you are reading. :)

What happens if I fail the return-to-sport ACL testing?

In clinic, I’ve seen many athletes perform much worse then they normally would, because of the nerves. I get it, it feels like the last 12 months of your life are on the line. Maybe you have the pressure from the parents, maybe from the coaches, maybe a scholarship on the line. Or maybe you are just so ready to get back to doing what you love.

However, just like anything else in life it’s all in your mindset. Think: “can I learn something from this?” vs “pass or fail,” and all of a sudden the ACL return to sport testing becomes a helpful tool, rather then your enemy. These tests will give you a lot of valuable information about the points of weakness. The tests become a source of information that gives you a chance to improve and become a better athlete. You might have to go back to drawing board and make sure you’ve met all the previous criteria.

Remember, the end does not justify the means. Getting a pass or fail is not the end-all goal. Rather, making sure that you are strong enough and safe enough for your sport is.

Want to know more? Join my Facebook group, it’s for everyone seeking information on ACL injury prevention, recovery, and screening. 👇