Review article - (2026)25, 772 - 806
DOI: https://doi.org/10.52082/jssm.2026.772
Hop Test Performance is Associated with Return-to-Sport but Shows Limited Association with Reinjury after Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis
Yiyan Liu1†, Yuxin Sun2†, Mingde Cao3, Dan Wang4, Lin Wang1, Daniel T.P. Fong5, Patrick Shu-Hang Yung3, Jihong Qiu1,
1School of Exercise and Health, Shanghai University of Sport, Shanghai, China
2Department of Rehabilitation, Shanghai Changhai Hospital, Shanghai, China
3Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
4School of Athletic Performance, Shanghai University of Sport, Shanghai, China
5National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK

Jihong Qiu
✉ School of Exercise and Health, Shanghai University of Sport, Shanghai, China
Email: qiujihong@sus.edu.cn
Received: 06-04-2026 -- Accepted: 14-08-2026
Published (online): 01-09-2026
Narrated in English
ABSTRACT

Hop tests are commonly used to assess return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR), yet whether they can effectively predict successful RTS and reinjury risk remains unclear. This systematic review and meta-analysis aimed to determine the associations between hop test performance and the likelihood of RTS and reinjury following ACLR. PubMed, SPORTDiscus with Full Text, MEDLINE and Web of Science were searched for studies that included participants with primary unilateral ACLR, assessed functional performance using hop tests and reported outcomes of RTS and reinjury. Data on participant characteristics, follow-up duration, RTS criteria, hop test types and measures, and relevant results were extracted. Data were synthesized using quantitative or qualitative approaches. Risk of bias was assessed using a modified Newcastle-Ottawa Scale, and the quality of evidence was evaluated with the modified GRADE framework. Forty-three studies involving 17, 350 participants were included. Twenty-four studies investigated RTS and 21 examined reinjury. Meta-analyses revealed achieving a limb symmetry index (LSI) ≥ 90% in single-leg hop for distance (SLHD) (OR = 1.20, 95% CI: 1.09 to 1.33) or triple crossover hop for distance (TCHD) (OR = 1.18, 95% CI: 1.02 to 1.36) was associated with a higher probability of RTS, whereas achieving LSI ≥ 90% in triple hop for distance (OR = 1.05, 95% CI: 1.01 to 1.09) was associated with increased odds of reinjury. Subgroup analyses showed stronger associations for RTS in studies with > 90% hamstring tendon autografts (OR = 1.64, 95% CI: 1.13 to 2.39) and among individuals without meniscal injury (OR = 1.39, 95% CI: 1.14 to 1.69). Overall, low certainty of evidence suggests achieving an LSI ≥ 90% in SLHD and TCHD is associated with a higher likelihood of RTS within two years after ACLR, particularly in individuals with hamstring autografts and without meniscal injury. However, distance-based performance of hop test alone may be insufficient to predict reinjury risk.
Key words: Knee joint, ligamentous injuries, functional performance, return to play, secondary ACL injury

Key Points
  • A limb symmetry index (LSI) ≥ 90% in the single-leg hop for distance and triple crossover hop for distance was associated with a higher likelihood of successful return to sports following ACLR.
  • An LSI ≥ 90% in the trip hop for distance was associated with a modestly higher risk of ACL reinjury following ACLR.
  • An LSI threshold of ≥ 90% was the most frequently adopted criterion for hop test assessment after ACLR.
  • Current evidence suggests that hop tests are more useful for assessing RTS readiness than reinjury risk, supporting the development of more comprehensive RTS assessment criteria.








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Hop Test Performance is Associated with Return-to-Sport but Shows Limited Association with Reinjury after Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis
Yiyan Liu, Yuxin Sun, Mingde Cao, Dan Wang, Lin Wang, Daniel T.P. Fong, Patrick Shu-Hang Yung, Jihong Qiu
2026(25), 772 - 806.
DOI: https://doi.org/10.52082/jssm.2026.772