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Performance and symmetry measures during vertical jump testing at return to sport after ACL reconstruction
  1. Roula Kotsifaki1,2,
  2. Vasileios Sideris1,
  3. Enda King1,3,
  4. Roald Bahr2,4,
  5. Rod Whiteley1,5
  1. 1 Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  3. 3 Department of Life Sciences, Roehampton University, London, UK
  4. 4 Aspetar Sports Injury and Illness Prevention Programme (ASPREV), Aspetar, Orthopeadic and Sports Medicine Hospital, Doha, Qatar
  5. 5 School of Human Movement & Nutrition Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
  1. Correspondence to Dr Roula Kotsifaki, Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha P.O. Box 29222, Qatar; argyro.kotsifaki{at}


Objective Vertical jump tests are more sensitive in revealing asymmetries in performance metrics at the time of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) than horizontal hop tests. However, it remains unclear which vertical tests (bilateral or unilateral) and which metrics (kinetics or performance) are most effective in informing the rehabilitation status and readiness for return to sport. We aimed to investigate the status of athletes during vertical jump testing at return to sport after ACLR.

Methods A dual force platform system was used to evaluate jumping performance of 126 recreational and professional athletes at the time of return to sport after ACLR, as well as 532 healthy control participants. Performance and kinetic metrics were collected during four jump tests: double-leg countermovement jump, single-leg countermovement jump, double-leg 30 cm drop jump and single-leg 15 cm drop jump. Between-limb and between-group differences were explored using mixed models analyses.

Results At the time of return to sport after ACLR, athletes still presented significant differences favouring the uninvolved side, particularly in the symmetry of the concentric impulse (p<0.001) in all jumps compared with the control group. Peak landing force asymmetry was greater in the ACLR group than the controls during the countermovement (p<0.001, MD=−11.6; 95% CI –15.4 to –7.9) and the double-leg drop jump (p=0.023, MD=−8.9; 95% CI –14.9 to –2.8). The eccentric impulse asymmetry was significantly greater (p=0.018, MD=−3.8; 95% CI −5.8 to –1.7) in the ACLR group during the single-leg drop jump only. Jump height was significantly lower (p<0001) in the ACLR group compared with controls in all tests except the double-leg drop jump.

Conclusion At the time of return to sport after ACLR, despite passing the traditional discharge criteria, athletes remained asymmetrical during all vertical jump tests, in the concentric (push-off) phase, during landing from bilateral jumps and for most performance metrics. Clinicians should aim to restore not only symmetry in ground reaction forces but also absolute performance metrics such as jump height, reactive strength index and contact times, to potentially reduce injury risk and improve overall athletic performance.

  • Anterior Cruciate Ligament
  • Injury prevention
  • Rehabilitation
  • Sports

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors RK and RW participated in the conception and the design of the study. RK and VS were responsible for data collection. RK performed the data analysis and table designs and all the authors contributed to the interpretation. RK drafted the manuscript, and all the authors revised it critically and gave their approval of the final version. RK acted as the guarantor for the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.