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Measuring only hop distance during single leg hop testing is insufficient to detect deficits in knee function after ACL reconstruction: a systematic review and meta-analysis
  1. Argyro Kotsifaki1,2,
  2. Vasileios Korakakis1,
  3. Rod Whiteley1,
  4. Sam Van Rossom2,
  5. Ilse Jonkers2
  1. 1 Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
  1. Correspondence to Mrs Argyro Kotsifaki, Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha 29222, Qatar; argyro.kotsifaki{at}


Objective To systematically review the biomechanical deficits after ACL reconstruction (ACLR) during single leg hop for distance (SLHD) testing and report these differences compared with the contralateral leg and with healthy controls.

Design Systematic review with meta-analysis.

Data sources A systematic search in Pubmed (Ovid), EMBASE, CINAHL, Scopus, Web of Science, PEDro, SPORTDiscus, Cochrane Library, grey literature and trial registries, was conducted from inception to 1 April 2018.

Eligibility criteria for selecting studies Studies reporting kinematic, kinetic and/or electromyographic data of the ACLR limb during SLHD with no language limits.

Results The literature review yielded 1551 articles and 19 studies met the inclusion criteria. Meta-analysis revealed strong evidence of lower peak knee flexion angle and knee flexion moments during landing compared with the uninjured leg and with controls. Also, moderate evidence (with large effect size) of lower knee power absorption during landing compared with the uninjured leg. No difference was found in peak vertical ground reaction force during landing. Subgroup analyses revealed that some kinematic variables do not restore with time and may even worsen.

Conclusion During SLHD several kinematic and kinetic deficits were detected between limbs after ACLR, despite adequate SLHD performance. Measuring only hop distance, even using the healthy leg as a reference, is insufficient to fully assess knee function after ACLR.

PROSPERO trial registration number CRD42018087779.

  • ACL
  • sporting injuries
  • knee surgery
  • biomechanics
  • injury prevention

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  • Contributors All authors contributed significantly to the review. AK conducted the entire review, with VK and RW as second and third reviewers. SVR and IJ provided advice throughout the review. All authors contributed to the final manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.