ACL Testing Return To Sports

Testing battery recommended by the European Board of Sports Rehab (EBSR):

Recommended criteria for strength and hop performance prior to a return to sport after ACL reconstruction
Type of sport LSI strength LSI hop performance



100% on knee extensor as well as knee flexor strength 90% on two maximumᵃ as well as one endurableᵇ



90% on knee extensor as well as knee flexor strength 90% on one maximumᵃ or one endurableᵇ

ᵃ For example, a vertical jump and a hop for distance

ᵇ For example, the triple jump, stair hop or side hop test

Reprinted from Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction (Thomee et al, 2011)

Return to Sport Discharge Criteria

 Functional Testing Protocol

Category Tests Required Outcome
Special Tests for Swelling, Stability, and Range of Motion Lachman’s

Pivot Shift



Sport Specific Movements

(warm up)

Functional movements as part of a dynamic warm up Excellent technique rating during all movements
Single Leg Power, Stability, Balance Star Excursion Balance Test

Single leg hop for distance

Triple cross over hop test

Triple hop for distance

< 5% to other side

< 5% to other side

< 5% to other side

< 5% to other side

Bilateral Landing, Power Tuck jump test 100% score
Single Leg Strength 3RM Single Leg Incline Press

3RM Single Leg Hamstring Curl

Equal to other side

Equal to other side

Subjective Evaluation IKDC subjective knee evaluation form 95% +


Special Tests

Measure Outcome Pass Criteria
Lachmans Nil: No laxity, equal to other side

Mild: 0 to 5 mm laxity (greater than the uninvolved side)
Moderate: 6 to 10 mm laxity (greater than the uninvolved side)
Severe: 11 to 15 mm laxity (greater than the uninvolved side)

Pivot Shift 1 : Gentle twisting slide with tibia twisting internally maximally

2 : Clunk with tibia neutral, negative when tibia externally rotated

3: Painless glide for examiner and patient;
4 : Jamming and plowing, impingement;


Sport Specific Movements (included as part of warm up)

                                                Quality                                                                                 Quality

Forward/Backpedaling:              P • A • G • E                       Bounding:                          P • A • G • E

Side Shuttles:                                    P • A • G • E                       Shuttle Run:                       P • A • G • E

Carioca:                                               P • A • G • E                       High Knees:                        P • A • G • E

Gluteal Kicks:                                    P • A • G • E                       Other: _______                    P • A • G • E

Star Excursion Balance Test

  Right Left

Single Hop for Distance

R #1

R #2

R #3

L #1

L #2

L #3

Total R

Total L












P • A • G • E

Triple Cross Over Hop Test

R #1

R #2

R #3

L #1

L #2

L #3

Total R

Total L












P • A • G • E

 Single Hop for Distance

R #1

R #2

R #3

L #1

L #2

L #3

Total R

Total L












P • A • G • E

 Subjective Evaluation




(Total score / 87) x 100

 Limb Symmetry Index:

A limb symmetry index will be calculated from the average of 3 trials as the involved limb hop distance divided by the involved limb hop distance, multiplied by 100.

Tuck Jump Assessment:

Athletes perform repeated tuck jumps for 10 seconds while the clinician scores the performance for each category from frontal and sagittal planes (Myer et al, 2006).

Knee and Thigh Motion
- Lower extremity valgus at landing      
- Thighs do not reach parallel (peak of jump)      
- Thighs do not equal side to side (during flight)      
Foot Position During Landing
- Foot placement not shoulder width apart      
- Foot placement not parallel (front to back)      
- Foot contact timing not equal      
- Excessive landing contact noise      
Plyometric Technique
- Pause between jumps      
- Technique declines prior to 10 seconds      
- Does not land in same footprint

(excessive in flight motion)


Table reprinted from “Tuck jump assessment for reducing anterior cruciate ligament injury risk”. Myer et al, 2008

Single Leg Strength Tests

Test Left Right
Single Leg Incline Leg Press    
Single Leg Hamstring Curl    

Subjective Evaluation:

Patient reported outcome measures will be completed after all objective clinical measures have been collected

Follow up measures

To assist with the long term validity of the ARTS program, three subjective assessments will be conducted intermittently at the initial consult; testing for progression; and 12 months; 2 years; and 5 years following injury.

IKDC Subjective Knee Evaluation Form:

The IKDC was selected due to the strong focus on patient reported outcomes which reflect the concerns of athletes (Hambly & Konstandina, 2010)

Tegner activity grading scale:

Quantifies activity levels related to both work and sports in patients with ACL ruptures. A reliable tool to determine whether athletes return to previous levels of physical activity (Briggs et al, 2009).

Tampa Scale for Kinesiophobia (TSK-11):

Measures the pain-related fear associated with movement and re-injury. Increased levels of function have been associated with reduced levels of fear avoidance during ACL rehabilitation (Chmielewski et al, 2008).


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