• Science Fueling Fitness

ACL Return to Play Testing

The importance of staying compliant with a rehabilitation programme following ACL injury or ACL reconstruction surgery is well documented. Read more about that here! Throughout the rehabilitation process, it is important to monitor the athlete's rate of progress to assess the effectiveness of the programme and the level of function the athlete has regained. To do so, reliable and accurate tests which assess the athlete across various planes and movement patterns, are needed. The following six tests have been shown as valid and reliable methods to assess athletes returning from ACL injury. These tests are all easy to implement, time-efficient, require minimal equipment and are repeatable, which allows continuous evaluation of the athlete in their return to practice and competitive sport. Anecdotally, there is a learning effect with these tests so regular testing throughout the rehabilitation process is advised. While limb symmetry may be evident at initial testing, scores will naturally improve as the athlete progresses through their rehabilitation and it is only until a baseline score is achieved that we can begin to assess limb symmetry index accurately.





Single-Leg Balance Test


Athlete stands on one leg with the other leg flexed to unipedal stance and arms crossed over the chest. The athlete aims to maintain this position for as long as possible until the test is passed. This test is performed off each leg with eyes open, and then repeated off each leg with eyes closed.

Trial ends if any of the following occur:

  • Arms are uncrossed.

  • Raised foot touches either the ground or the stance leg.

  • Movement of the stance foot.


Passing Score:

  • Eyes open = 43 seconds

  • Eyes closed = 9 seconds





Star Excursion Balance Test


Single-leg test. Athletes stands on one leg and reaches as far as possible with the other leg, in 8 directions from the base position, each at 45 degrees from the next. The athlete must keep a solid stance foot (toe and heel on the ground) and cannot shift position throughout the test. A modified, shorter version of this test can be performed with the athlete reaching in one direction only (forward) off each leg and comparing results.

Trial ends if any of the following occur:

  • Athlete touches the tape heavily.

  • Athletes makes contact with the ground either to maintain balance whilst reaching or whilst returning to the start position.

  • Athlete shifts position of stance leg to accommodate a further reach.

Scoring System:

  • A total of three trials per leg may be attempted.

  • The average of the three trials is recorded.


Passing Score:

  • Injured leg within 95% of un-injured leg.





Single Linear Hop Test


Single-leg test. Athlete jumps off one leg for distance and ‘sticks’ the landing on the same leg. The aim is to jump as far forward as possible. The athlete must stick the landing for 2 seconds otherwise the jump is invalid and not counted.

Scoring System:

  • A total of three trials per leg may be attempted.

  • The average score and the best score from the three trials is recorded.

Passing Score:

  • Injured leg within 90% of un-injured leg.





Triple Linear Hop Test


Single-leg test. Athlete jumps forward off one leg, three consecutive times, aiming to get as far as possible and stick the landing on the last hop. The aim is to jump as far forward as possible with the three hops. The athlete must stick the last landing for 2 seconds otherwise the attempt is invalid and not counted.

Scoring System:

  • A total of three trials per leg may be attempted.

  • The average score and the best score from the three trials is recorded.

Passing Score:

  • Injured leg within 90% of un-injured leg.



Triple Crossover Hop Test


Single-leg test. This test is performed with a line marked along the ground, 15cm in width and approximately 7-8m long. The athlete starts standing on the leg closest to the line, and hops forwards three times, crossing the line with each hop. The aim is to hop as far as possible without touching the line. The athlete must stick the last landing for 2 seconds otherwise the attempt is invalid and not counted.

Scoring System:

  • A total of three trials per leg may be attempted.

  • The average score and the best score from the three trials is recorded.

Passing Score:

  • Injured leg within 90% of un-injured leg.




Continuous Lateral Hop Test


Single-leg test. This test is performed with two parallel lines marked along the ground, 40cm apart, which the athlete will hop across laterally and continuously for a period of 30 seconds. The aim is to hop back and forth as many times as possible without touching either line. If the line is touched, that hop is not counted, but the test continues.

Scoring System:

  • A total of two trials per leg may be attempted. The best score for each leg is used.

  • Score refers to the total number of hops, minus the number of times either line was touched.

  • If the athlete touches either line with a hop, that repetition is not counted but the test continues.

  • If the athlete touches either line with more than 25% of their hops, the attempt is invalid and not counted.

  • If the athlete places the non-involved foot on the ground, that repetition is not counted but the test continues.

Passing Score:

  • Injured leg within 90% of un-injured leg.




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