Unilateral tests of lower-limb function as prognostic indicators of future knee-related outcomes following anterior cruciate ligament injury: a systematic review and meta-analysis of 13150 adolescents and adults

Review written by Dr Travis Pollen info

Key Points

  1. Clinicians commonly use limb symmetry indices (LSIs) on hop tests to assess athletes’ readiness to return to sport after an anterior cruciate ligament (ACL) injury.
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To assess athletes’ readiness to return to sport (RTS) post-anterior cruciate ligament (ACL) injury, clinicians commonly use limb symmetry indices (LSIs) on hop tests. However, the evidence for the associations between hop tests and outcomes is conflicting, both when hops tests are examined individually (1,2) and as part of larger test batteries (3,4).

The purpose of this systematic review and meta-analysis was to examine the association between hop tests (individually and as part of test batteries) and future knee-related outcomes post-ACL injury.

Limb symmetry indices are commonly used to assess an athletes return to sport readiness post-anterior cruciate ligament injury.
Clinicians should consider other established factors such as time, age, strength, and psychological recovery when appraising subsequent injury risk.


  • This systematic review included a total of 42 studies comprising 13,150 participants.
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