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What tests should be used to assess functional performance in youth and young adults following anterior cruciate ligament or meniscal injury? A systematic review of measurement properties for the OPTIKNEE consensus
  1. Bjørnar Berg1,2,
  2. Anouk P Urhausen3,
  3. Britt Elin Øiestad4,
  4. Jackie L Whittaker5,6,
  5. Adam G Culvenor7,
  6. Ewa M Roos8,
  7. Kay M Crossley7,
  8. Carsten B Juhl8,9,
  9. May Arna Risberg1,3
  1. 1Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
  2. 2Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
  3. 3Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  4. 4Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
  5. 5Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  6. 6Arthritis Research Centre, Vancouver, Vancouver, Canada
  7. 7La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Bundoora, Victoria, Australia
  8. 8Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  9. 9Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Kobenhavn, Denmark
  1. Correspondence to Dr Bjørnar Berg, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo 0424, Norway; bjornar.berg{at}


Objectives To critically appraise and summarise measurement properties of functional performance tests in individuals following anterior cruciate ligament (ACL) or meniscal injury.

Design Systematic review.

Data sources Systematic searches were performed in Medline (Ovid), Embase (Ovid), CINAHL (EBSCO) and SPORTSDiscus (EBSCO) on 7 July 2021.

Eligibility criteria for selecting studies Studies evaluating at least one measurement property of a functional performance test including individuals following an ACL tear or meniscal injury with a mean injury age of ≤30 years. The COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist was used to assess methodological quality. A modified Grading of Recommendations Assessment, Development and Evaluation assessed evidence quality.

Results Thirty studies evaluating 26 functional performance tests following ACL injury were included. No studies were found in individuals with an isolated meniscal injury. Included studies evaluated reliability (n=5), measurement error (n=3), construct validity (n=26), structural validity (n=1) and responsiveness (n=1). The Single Leg Hop and Crossover Hop tests showed sufficient intrarater reliability (high and moderate quality evidence, respectively), construct validity (low-quality and moderate-quality evidence, respectively) and responsiveness (low-quality evidence).

Conclusion Frequently used functional performance tests for individuals with ACL or meniscal injury lack evidence supporting their measurement properties. The Single Leg Hop and Crossover Hop are currently the most promising tests following ACL injury. High-quality studies are required to facilitate stronger recommendations of performance-based outcomes following ACL or meniscal injury.

  • knee
  • anterior cruciate ligament

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  • Twitter @AnoukUrhausen, @jwhittak_physio, @agculvenor, @ewa_roos

  • Contributors JLW, AGC, EMR, KMC, CBJ and MAR contributed to the conception of the study. BB, APU, BEØ and MAR designed the study. BB and APU screened studies for inclusion, performed risk of bias assessment and data extraction. All authors contributed to the interpretation of data. BB wrote the initial draft. All authors revised the draft critically for important intellectual content and approved the final version.

  • Funding This review is part of the OPTIKNEE consensus ( which has received funding from the Canadian Institutes of Health Research (OPTIKNEE principal investigator JLW #161821).

  • Disclaimer The funders had no role in any part of the study or in any decision about publication.

  • Competing interests JLW and AGC are Associate Editors of the British Journal of Sports Medicine (BJSM). JLW is an Editor with the Journal of Orthopaedic and Sports Physical Therapy. KMC is a senior advisor of BJSM, project leader of the Good Life with Osteoarthritis from Denmark (GLA:D)-Australia a not-for profit initiative to implement clinical guidelines in primary care, and holds a research grant from Levin Health outside the submitted work. CBJ an Associate Editor of Osteoarthritis and Cartilage. ER is Deputy Editor of Osteoarthritis and Cartilage, developer of Knee injury and Osteoarthritis Outcome Score (KOOS) and several other freely available patient-reported outcome measures, and founder of the GLA:D). All other authors declare no competing interests.

  • 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.

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