Vertical jump testing after anterior cruciate ligament reconstruction: A systematic review and meta-analysis

INTRODUCTION: Recently, there has been a call for vertical jump testing via force-plate analysis to be included in the assessment of individuals after anterior cruciate ligament reconstruction (ACLR) and as part of return-to-play criteria. However, a synthesis of current literature is needed to help guide clinicians on what tests to perform, which force-plate metrics to assess, and how these may change over the time course of rehabilitation.

METHODS: Four online databases were searched from inception to July 2022. The Downs and Black checklist was used to assess study quality. Multilevel meta-analyses and meta-regressions were undertaken in conjunction with a best evidence synthesis.

RESULTS: Forty-two articles were included, capturing 2375 participants with a history of ACLR. Reconstructed limbs displayed 1) lower peak eccentric forces, concentric forces, landing forces, and lower eccentric and concentric impulses (standardized means difference [SMD] = -1.84 to -0.46) than uninjured contralateral limbs during bilateral countermovement jumps (CMJ) and drop vertical jumps (DVJ); 2) lower jump heights and reactive strength indices (RSI), and longer contact times than uninjured contralateral limbs during unilateral CMJ and DVJ (SMD = -0.86 to 0.26); and 3) lower jump heights, RSI, and longer contact times during bilateral and unilateral CMJ, and unilateral DVJ, than uninjured controls (SMD = -1.19 to 1.08). Meta-regression revealed that time postsurgery was a significant moderator ( P < 0.05) for 1) bilateral CMJ height, peak concentric force, and peak landing force; 2) between-limb differences in unilateral CMJ height; and 3) differences in unilateral DVJ height, RSI, and contact time between reconstructed limbs and healthy controls with no history of injury.

CONCLUSIONS: Individuals with a history of ACLR display chronic deficits in vertical jumping performance during a range of bilateral and unilateral tasks, which may have implications for return-to-play criteria and the design of interventions targeted at restoring long-term deficits in explosive lower limb strength after ACLR.