Interlimb Symmetry and Hop Testing After ACL Reconstruction: A Systematic Review and an Adolescent Cohort

Physical therapists and physical therapist assistants who work with athletes during and after ACL rehabilitation, and who see limb symmetry index numbers used in progression and return-to-sport conversations.

Physical therapists and physical therapist assistants in outpatient orthopedics, sports medicine, and pediatric or high school athletic settings. Physical therapist assistants may take this course; the content describes their contribution as work carried out under the direction and supervision of the physical therapist, who retains evaluation, diagnosis, and plan-of-care decisions.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

Pathmanathan C, Herrera N, Côté JN, Robbins S. Interlimb Symmetry Characteristics Among Male and Female Athletes: A Systematic Review. JOSPT Open. 2026;4(1):36-60. doi:10.2519/josptopen.2025.0137

Ciccodicola EM, Hanson AM, Roberts SE, Katzel MJ, Wren TAL. Asymmetry of Single-Leg Vertical Hop Performance and Biomechanics in Adolescent Athletes With Anterior Cruciate Ligament Reconstruction. JOSPT Open. 2026;4(3):321-327. doi:10.2519/josptopen.2026.0199

After completing this course, you will be able to:

1. Describe what the systematic review of male and female athletes reported about interlimb asymmetry measured in uninjured limbs, including how consistent the findings were across studies.
2. State what the retrospective cohort of adolescents after ACL reconstruction found about single-leg vertical hop height symmetry and about how the reconstructed knee loaded during takeoff and landing.
3. Explain why a limb symmetry index threshold is a measurement convention rather than a proven clearance standard, and distinguish where the two papers agreed and where they reported different things.

1. Start Here: The Question This Course Answers
2. Part One: Interlimb Asymmetry Measured in Uninjured Male and Female Athletes
3. Which Athletes the Symmetry Review Included
4. How the Review Searched, Appraised, and Summarized the Literature
5. What the Review Found About Side-to-Side Differences in Men and Women
6. What the Review's Authors Concluded, and Where the Evidence Was Thin
7. Part Two: Single-Leg Vertical Hop Asymmetry in Adolescents After ACL Reconstruction
8. The Adolescents Behind the Single-Leg Vertical Hop Data
9. How Hop Height and Joint Loading Were Measured
10. Hop Height Symmetry Alongside Knee Offloading at Takeoff and Landing
11. Psychological Readiness, Study Limits, and the Authors' Conclusion
12. Bringing It Together
13. Where Both Papers Point the Same Way
14. Where the Two Papers Part Company
15. Reading a Limb Symmetry Index at the Treatment Table
16. Open Questions and the Physical Therapist Assistant's Contribution
17. Key Takeaways
18. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 1.0 contact hour (60 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. Pathmanathan C, Herrera N, Côté JN, Robbins S. Interlimb Symmetry Characteristics Among Male and Female Athletes: A Systematic Review. JOSPT Open. 2026;4(1):36-60. doi:10.2519/josptopen.2025.0137
2. Ciccodicola EM, Hanson AM, Roberts SE, Katzel MJ, Wren TAL. Asymmetry of Single-Leg Vertical Hop Performance and Biomechanics in Adolescent Athletes With Anterior Cruciate Ligament Reconstruction. JOSPT Open. 2026;4(3):321-327. doi:10.2519/josptopen.2026.0199