Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part I: development of a new test battery

Knee Surg Sports Traumatol Arthrosc. 2015 May;23(5):1273-81. doi: 10.1007/s00167-015-3529-4. Epub 2015 Feb 15.


Purpose: Return to activity remains the most common concern following an injury. To facilitate the decision regarding a patient's return to sport, we developed a standardized and easy-to-use test battery to enable an objective evaluation of knee function.

Methods: The test battery consisted of seven functional tests: the two-leg stability test, one-leg stability test (OL-ST), two-leg countermovement jump (CMJ), one-leg CMJ (OL-CMJ), plyometric jumps, speedy test and quick feet test. For each test, the reliability was determined based on the intraclass correlation coefficient. For all one-leg tests, the limb symmetry index (LSI) was calculated.

Results: All tests showed a moderate-to-high reliability. Normative data from 434 participants were included in the analysis. The subjects were categorized according to age as follows: children (10-14 years), youth (15-19 years), young adults (20-29 years) and adults (30-50 years). The establishment of the functional test values allowed the classification into five normative categories. The LSI for the OL-ST (98 %) indicated a better performance of the non-dominant leg. In contrast, high LSI values were found for the OL-CMJ (124 %), indicating a better performance of the dominant leg.

Conclusion: Each test was found to be reliable and simple to perform. The better performance of the non-dominant leg in stability tasks must be considered when interpreting side-to-side differences. The established norm data from healthy individuals of each test battery represents an important basis for a clinical setting. Test results from an ACL-reconstructed patient should be at least classified as a functionally average outcome to support a safe return to sports.

Level of evidence: IV.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries*
  • Anterior Cruciate Ligament Reconstruction / rehabilitation*
  • Child
  • Decision Making*
  • Exercise Test / methods
  • Female
  • Humans
  • Knee Injuries / rehabilitation*
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Return to Sport / physiology*
  • Young Adult