New Study: Assessing the Validity of the Triple Hop Distance as a Test for Return To Sports assessments

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Symmetry in Triple Hop Distance Hides Asymmetries in Knee Function After ACL Reconstruction in Athletes at Return to Sports

This research article, from The American Journal of Sports Medicine, evaluates the lower limb function of athletes after ACL reconstructive surgery and aims to question the effectiveness of the triple hop for distance test on athletes who have passed the return to sport (RTS) assessments.

This study was done in a controlled laboratory study and conducted on 47 male athletes: 

  • 24 athletes had undergone ACLR and were cleared to RTS 
    • The criteria for RTS was one of the following:
      (1) clearance by the surgeon and physical therapist
      (2) completion of a sports-specific on-field rehabilitation program
      (3) limb symmetry strength index <90% after quadriceps strength and hop battery tests. 
  • 23 athletes were healthy controls during the triple hop test. 
From here, lower limb and trunk kinematics were calculated and evaluated using mixed linear models.

The results revealed the following: 
  • The ACLR cohort achieved 97% limb symmetry in distance hopped and almost 80% symmetry for knee work absorption in the second rebound and third landing. 
  • However, the ACLR cohort demonstrated only 51% and 66% limb symmetry for knee work generation in the first and second rebound phases, respectively. 
  • During both work generation phases of the triple hop, the relative contribution of the involved knee was significantly smaller, with a prominent compensation from the hip joint, as compared with the uninvolved limb and the controls.
  • Also, patients deployed a whole body compensatory strategy to account for the between-limb differences in knee function, mainly at the hip, pelvis and trunk.  
The study concluded symmetry in the triple hop for distance test masked significant asymmetries in the knee function after ACLR and is not necessarily an accurate test for determining discharge criterion.



Performing a dorsaVi AMI (Athletic Movement Index) test is a more objective measure of readiness to RTS.

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