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Abnormal Lower Limb Symmetry Determined by Function Hop Tests after Anterior Cruciate Ligament Rupture.

·Am J Sports Med·1991·985 citations·Sports Medicine
DOI·PubMed
SummaryAbstract on PubMed →

Noyes et al. tested four one-legged hop tests in 67 chronic ACL-deficient patients to determine how well each detects functional limb asymmetry. A limb symmetry index (LSI) below 85% defined an abnormal result. The study asks: how many tests are needed, and which test performs best?

Study Snapshot

Design
Prospective cohort
Setting: Single center, Cincinnati
Funding: Cincinnati Sportsmedicine Foundation
Objective
Determine whether one-legged hop tests detect limb asymmetry in ACL-deficient knees
Outcome(s)
Limb symmetry index (<85% = abnormal) on four one-legged hop tests
Subjects
67 ACL-deficient patients + 97 historical normal controls
Inclusion
  • Chronic ACL rupture (positive Lachman + pivot shift)
  • No acute pain or joint effusion
  • No prior knee surgery or other ligament injury
Exclusion
  • Moderate patellofemoral pain/crepitus (excluded from isokinetic testing, n=13)
  • Ligament injury to opposite knee
Statistics
Chi-squareSingle linear regressionMultiple linear regressionStudent's paired t-test

Key Findings

  • Any single hop test detects abnormal limb symmetry in only 50–52% of confirmed ACL-deficient knees — meaning nearly half of patients test normal despite a ruptured ACL.
  • This low sensitivity is consistent across all four tests and was unchanged when the sample was nearly doubled from the prior study.
  • Using two hop tests together raises the detection rate to 62% abnormal, compared to 49–52% with either test alone.
  • The authors conclude clinicians should always administer at least two tests.
  • The LSI <85% threshold defines abnormal performance and is valid across sex, limb dominance, and activity level. It is the standard cutoff used in return-to-sport protocols today.
  • The cross-over hop is not more sensitive than simpler tests despite its apparent difficulty:
    –Cross-over hop sensitivity: 58%
    –Triple hop sensitivity: 50%
    –Single hop sensitivity: 52%
    –Timed hop sensitivity: 49%
  • No two-test combination outperformed any other.
  • Hop LSI correlates weakly with low-velocity quadriceps isokinetic deficit (P < 0.01, r = 0.49). A statistical trend, not a clinically predictive relationship.
  • KT-1000 laxity showed no correlation with hop performance at all, confirming that ligamentous laxity and functional capacity are separate constructs.
Board PearlA single hop test misses 50% of ACL-deficient patients — always use at least two hop tests and pair with isokinetic strength data.

Clinical Relevance

A normal hop test score does not clear an ACL patient. Half of patients with a confirmed ACL rupture and measurable laxity on KT-1000 will pass a single hop test. That result is not reassuring — it reflects the test's ceiling, not the patient's recovery.

In clinic, always run at least two hop tests. The detection rate rises from ~50% to 62% with a second test, and no single combination is superior, so choose based on availability and patient tolerance.

Pair hop data with isokinetic quadriceps strength testing. The correlation is weak (r = 0.49), but abnormal low-velocity quadriceps deficit (present in 69% of this cohort) provides independent confirmation of deficit that hop tests may miss.

Think of hop tests as confirmation tools, not screening tools. A positive result (LSI <85%) confirms functional asymmetry. A negative result leaves the question open. In a symptomatic patient with a normal hop score, dig deeper. Don't downgrade your concern.

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|

Abnormal Lower Limb Symmetry Determined by Function Hop Tests after Anterior Cruciate Ligament Rupture.

·Am J Sports Med·1991·985 citations·Sports Medicine
DOI·PubMed
SummaryAbstract on PubMed →

Noyes et al. tested four one-legged hop tests in 67 chronic ACL-deficient patients to determine how well each detects functional limb asymmetry. A limb symmetry index (LSI) below 85% defined an abnormal result. The study asks: how many tests are needed, and which test performs best?

Study Snapshot

Design
Prospective cohort
Setting: Single center, Cincinnati
Funding: Cincinnati Sportsmedicine Foundation
Objective
Determine whether one-legged hop tests detect limb asymmetry in ACL-deficient knees
Outcome(s)
Limb symmetry index (<85% = abnormal) on four one-legged hop tests
Subjects
67 ACL-deficient patients + 97 historical normal controls
Inclusion
  • Chronic ACL rupture (positive Lachman + pivot shift)
  • No acute pain or joint effusion
  • No prior knee surgery or other ligament injury
Exclusion
  • Moderate patellofemoral pain/crepitus (excluded from isokinetic testing, n=13)
  • Ligament injury to opposite knee
Statistics
Chi-squareSingle linear regressionMultiple linear regressionStudent's paired t-test

Key Findings

  • Any single hop test detects abnormal limb symmetry in only 50–52% of confirmed ACL-deficient knees — meaning nearly half of patients test normal despite a ruptured ACL.
  • This low sensitivity is consistent across all four tests and was unchanged when the sample was nearly doubled from the prior study.
  • Using two hop tests together raises the detection rate to 62% abnormal, compared to 49–52% with either test alone.
  • The authors conclude clinicians should always administer at least two tests.
  • The LSI <85% threshold defines abnormal performance and is valid across sex, limb dominance, and activity level. It is the standard cutoff used in return-to-sport protocols today.
  • The cross-over hop is not more sensitive than simpler tests despite its apparent difficulty:
    –Cross-over hop sensitivity: 58%
    –Triple hop sensitivity: 50%
    –Single hop sensitivity: 52%
    –Timed hop sensitivity: 49%
  • No two-test combination outperformed any other.
  • Hop LSI correlates weakly with low-velocity quadriceps isokinetic deficit (P < 0.01, r = 0.49). A statistical trend, not a clinically predictive relationship.
  • KT-1000 laxity showed no correlation with hop performance at all, confirming that ligamentous laxity and functional capacity are separate constructs.
Board PearlA single hop test misses 50% of ACL-deficient patients — always use at least two hop tests and pair with isokinetic strength data.

Clinical Relevance

A normal hop test score does not clear an ACL patient. Half of patients with a confirmed ACL rupture and measurable laxity on KT-1000 will pass a single hop test. That result is not reassuring — it reflects the test's ceiling, not the patient's recovery.

In clinic, always run at least two hop tests. The detection rate rises from ~50% to 62% with a second test, and no single combination is superior, so choose based on availability and patient tolerance.

Pair hop data with isokinetic quadriceps strength testing. The correlation is weak (r = 0.49), but abnormal low-velocity quadriceps deficit (present in 69% of this cohort) provides independent confirmation of deficit that hop tests may miss.

Think of hop tests as confirmation tools, not screening tools. A positive result (LSI <85%) confirms functional asymmetry. A negative result leaves the question open. In a symptomatic patient with a normal hop score, dig deeper. Don't downgrade your concern.

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