Hop Test Cluster by Gustavsson | ACL Return to Play Testing
The hop tests of Gustavsson test maximum single-leg hop performance and performance under increasing fatigue. There are three tests: The vertical jump test, the hop for distance, and the side hop test. The goal of the tests is to discriminate between the hop performance of the injured and the uninjured side in patients with an ACL injury and ACL reconstruction.
ICC values for all tests ranged from 0.85 to 0.97, so all individual tests had high test-retest reliability. Additionally, the battery was able to identify healthy subjects with an accuracy of 84% in the case of 3 tests with a normal LSI value. Patients were classified as “abnormal” with an accuracy of 88% in the case of 1 or more tests with an abnormal LSI value at 6 and 11 months after reconstruction. For this reason, we give this test battery a high clinical value in practice.
1. Vertical Jump
The vertical jump test is performed as a countermovement jump. The starting position the upright position with the hands placed behind the back. The patient quickly bents his knee as much as desired and then immediately jumped upwards, attempting to maximize the height of the jump. A computerized system serving as a ‘‘contact mat’’, makes it possible to measure the flight time. The system then converts the flight time into jump height in centimeters. This is an expensive tool and is not available in every physical therapy practice. An easy and free option is downloading the MyJump2 app, which can be used as a valid tool to measure jump height performance according to a study by Haynes et al. (2019).
2. Hop for Distance
For the hop-for-distance test, the patient stands on the test leg and then hops as far as possible while landing on the same leg. A free leg swing is allowed and the hands are placed behind the back. The patient is instructed to perform a controlled, balanced landing and to keep the landing foot in place. So no extra hops are allowed until the examiner has registered the landing position. Failure to do so results in a disqualified hop. The distance is measured in centimeters from the toe at the push-off to the heel where the subject landed.
3. Side Hop
For the side hop test, the patient stands on the test leg with their hands behind their back. The patient jumps from side to side between two parallel strips of tape, placed 40 centimeters apart on the floor. The patient is instructed to jump as many times as possible during a period of 30 seconds. The number of successful jumps performed, without touching the tape, is recorded. Touching the tape is recorded as an error, and if more than 25% of the jumps have errors, the second trial of 30 sec is performed after a 3-minutes rest period.
In order to score the tests, the lower limb symmetry index needs to be calculated to determine whether a side-to-side leg difference was classified as normal or abnormal. The limb symmetry index is defined as the ratio of the involved limb score and the uninvolved limb score expressed in percent. So the centimeters of the involved divided by the centimeters of the uninvolved leg multiplied by 100:
Involved limb score/uninvolved limb score x 100 = Leg symmetry index (LSI).
A limb symmetry score of >90 is generally classified as normal.
This test cluster can be used to evaluate progression during rehab and to help return to sport decision-making. Be aware that the limb Symmetry Index can overestimate knee function. The uninvolved limb is used as healthy control, but it doesn’t guarantee that the prior functional level of the uninvolved leg is reached. A study from Gokeler et al. (2017) showed that athletes who have undergone an ACL reconstruction demonstrate bilateral deficits on hop tests compared to age and sex-matched normative data of healthy controls. Comparison with pre-injury test data and normative values for age, sex, and sports could be more beneficial in the return to sport decision-making.
It could be beneficial to perform the tests in a fatigued state as well. A study from Augustsson in the year 2014 tested a group of people after ACL reconstruction with an LSI above 90%. When this group was tested in a fatigued state, only 32% were able to achieve the 90% or more. To conclude we can say that these tests are really useful in the rehabilitation process. However, in isolation, they are only one part to clear a patient for return to sport.
Other useful performance tests that you might be interested in are:
Gustavsson, A., Neeter, C., Thomeé, P., Grävare Silbernagel, K., Augustsson, J., Thomeé, R., & Karlsson, J. (2006). A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction. Knee surgery, sports traumatology, arthroscopy, 14(8), 778-788.
Augustsson, J., Thomeé, R., & Karlsson, J. (2004). Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 12(5), 350-356.
Gokeler, A., Welling, W., Benjaminse, A., Lemmink, K., Seil, R., & Zaffagnini, S. (2017). A critical analysis of limb symmetry indices of hop tests in athletes after anterior cruciate ligament reconstruction: a case control study. Orthopaedics & traumatology: surgery & research, 103(6), 947-951.
Wellsandt, E., Failla, M. J., & Snyder-Mackler, L. (2017). Limb symmetry indexes can overestimate knee function after anterior cruciate ligament injury. journal of orthopaedic & sports physical therapy, 47(5), 334-338.
Haynes, T., Bishop, C., Antrobus, M., & Brazier, J. (2019). The validity and reliability of the My Jump 2 app for measuring the reactive strength index and drop jump performance. The Journal of sports medicine and physical fitness.
- Els de Wael24/04/23ACL Injuries: From Theory to Practice SUPER INTERESSANTE CURSUS
Heel uitgebreide cursus over de ACL met duidelijke fasering en een groot aanbod van oefeningen en testen.
Super veel uit geleerd, echt een meerwaarde!Ben Moes08/01/23ACL Injuries: From Theory to Practice GREAT ACL COURSE
Can only recommend this course for any student or even working physiotherapist as it brings great evidence-based insight into the ACL-RehabilitationsMichal Wajdeczko02/12/22ACL Injuries: From Theory to Practice GREAT OPPORTUNITY TO BE A PROFESSIONAL.
The ” ACL injury From theory to practice” course is definitely one of the best I’ve ever had. Lots of useful practical and theoretical notes. All information were collected in a chronological whole, based on scientific medical evidence. Clear videos en practical advise makes this course more attractive. I really enjoyed the course and I advise it to everyone.
- Damie van Gijzen31/10/22ACL Injuries: From Theory to Practice VERY INFORMATIVE COURSE
If you want to learn a ACL course with different ways to treat the patient, from the begin to the end, than this is an very good course to learn.Verena Fric12/03/22ACL Injuries: From Theory to Practice Lots of relevant informationen around ACL, many ideas how to manage in practice and especially in late phase after ACL Surgery. I defintively recommand this course to everyone who wants to be update and increase his/her knowledge about ACL Rehab.Omar12/03/22ACL Injuries: From Theory to Practice VERY INFORMATIVE COURSE!
Can’t be more satisfied with this course content that cover all aspects in the ACL management
- Mostafa12/01/22ACL Injuries: From Theory to Practice THE BEST OF THE BEST!
I am a physiotherapist from Egypt and I have been working in the sports field for two years and dealt with many cases of ACL, but I always stood at certain points and i couldnt understand what was happening and I had many questions that I did not know the answer to, and after I took this course Many points became clear to me, and I had much more confidence in dealing with ACL cases.
I recommend this course to everyone who deals with acl cases , because it is really as it is in the title, from theory to practice.
I would like to thank Dr. Bart and Physiotutors for their wonderful effort.Nicolas14/08/21ACL Injuries: From Theory to Practice Very complete course covering all the problems that can be encountered in clinical practice. From understanding the mechanisms of injury to injury prevention and return to performance. Lots of information, all based on recent scientific literature and the instructor’s experience. Thanks Bart & Physiotutors !JOSÉ GUALÃO27/05/21ACL Injuries: From Theory to Practice VERY GOOD
Extremely happy with the content
- David05/04/21ACL Injuries: From Theory to Practice TOP!
Cursus die van A tot Z weergeeft wat een ACL letsel is en hoe de aanpak moet zijn! Het volgen van deze cursus is echt nodig om ACL optimal rehab te kunnen aanbieden.SEPPE13/12/20ACL Injuries: From Theory to Practice EVERYTHING YOU NEED TO KNOW ABOUT ACL INJURIES!
This is the most complete course ever. It contains everything you need to know about ACL injuries. I strongly recommend it to everyone!PAVEL SASMSONOV28/10/20ACL Injuries: From Theory to Practice OUTSTANDING COURSE!
This course is more than just webinar. It gives you deep understanding of different aspects and principles of rehabilitation ACL injured and reconstructed patients. Thank you, Bart and all Physiotutors team for uptodated information on different topics regarding this definetly tough topic. Despite that fact that I had some experience working with different ACL-patients I got structured whole information and gained a lot of new ideas to implement into my clinical practise!
Thank you so much!
- ANDRÉ23/10/20ACL Injuries: From Theory to Practice JUST DO IT!
This course have been nothing but great. So much good information and you can expect to learn a whole lot about all factors affecting the rehabilitation. It was worth every penny and I really recommend anyone treating patients with ACL-injuries to enroll in this course.HELEN04/10/20EVERYTHING YOU NEED TO KNOW ABOUT ACL INJURIES
This really is a fabulous course. Everything you need to know about ACL injuries and rehabilitation is discussed and supported by research. I would highly recommend this course – thank you Bart!PEDRO J.01/08/20ACL Injuries: From Theory to Practice GREAT COURSE!
I think it’s the most comprehensive course on ACL right now. It perfectly addresses the latest updates on the subject. My congratulations to the whole team for the course and to Bart Dingenen for sharing all his work. Greetings!
- Ben Saldivar27/05/20ACL Injuries: From Theory to Practice If you want to provide the best possible care to your ACL patients this course is a must.
Extremely detailed over all areas. Nothing else I’ve seen like it. Great job guys.Damie van Gijzen01/01/70ACL Injuries: From Theory to Practice VERY INFORMATIVE COURSE
If you want to learn a ACL course with different ways to treat the patient, from the begin to the end, than this is an very good course to learn.