 
Graft Type (circle):  
 
Autograft 
 
 
Hamstring 
 
BPTB 
 
Quad 
 
 
 
 
Allograft 
 
 
Achilles  
               BPTB 
 
Other 
Concomitant Injuries/Procedures:   
 
 
 
 
 
 
                 
                
 
 
 
Operative Limb 
Non-operative Limb 
Limb Symmetry 
Index 
Range of motion ( X-0-X) 
-0- 
-0- 
- 
Pain ( 0-10) 
/10 
/10 
- 
Knee Effusion 
 
 
- 
Strength Tests (lbs/in2) 
 
 
 
Hamstring Strength (Avg/ 3 trials) 
 
 
% 
Hip Abduction Strength (Avg/ 3 trials) 
 
 
% 
Quad strength (Avg/ 3 trials) 
 
 
% 
Hop Tests (cm) 
 
 
 
- 
Single Leg Hop for distance 
 
 
% 
- 
Triple Hop for distance 
 
 
% 
- 
Crossover Hop for distance 
 
 
% 
Motor Control Tests 
 
 
 
- 
Lateral step down (80 bpm) 
min   sec 
min   sec 
- 
- 
Lateral leap and catch (40 bpm) 
sec 
- 
- 
Calculated 1 RM (Single Leg Press) 
 
 
 
Y Balance Test 
 
 
 
 
Vertical Jump 
 
 
 
IKDC-2000 
 
Anterior Cruciate Ligament Return to Sport After 
Injury (ACL – RSI) 
 
 
 
 
 
Massachusetts General Brigham Sports Medicine  
 
2 
Explanation of Tests: 
Pain is recorded as an average value over the past 2 weeks, from 0-10.  0 is absolutely no pain, and 10 is the worst pain 
ever experienced. 
 
Knee Effusion is tested using the Modified Stroke Test.  An upstroke is applied to medial side of knee, followed by 
downstroke on lateral side.  The therapist observes for movement of fluid with each stroke. 
- 
0: no wave produced with downward stroke 
- 
Trace: small wave of fluid on medial side of knee 
- 
1+: large bulge of fluid on medial side of knee with downstroke 
- 
2+: Effusion returns to medial side of knee without downstroke 
- 
3+: inability to move effusion from medial side of knee 
 
Gluteus Medius strength is measured using a handheld dynamometer. The patient is positioned in side lying with the 
test knee is full extension and the test hip in slight extension. The HHD is placed just proximal to the lateral malleolus. 
The patient is instructed to apply a maximal isometric effort force against the HHD and the average of 3 trials is recorded 
for each limb. 
 
Quadriceps strength is measured using a handheld dynamometer.  The patient is secured in 60 degrees of knee flexion 
and the HHD is placed between the patient’s tibia and the resistance arm, 1 inch proximal to the midline between the 
malleoli.  The patient is instructed to apply a maximal isometric effort force against the HHD and the average of 3 trials is 
recorded for each limb.  If available ISOKINETIC CON-CON @ 60, 180, and 240 degrees/sec, 90-30 degrees of ROM. 
 
Hamstring strength is measured using a handheld dynamometer.  The patient is secured in 60 degrees of knee flexion 
and the HHD is placed between the patient’s lower leg and the resistance arm, 1 inch proximal to the midline between 
the malleoli.  The patient is instructed to apply a maximal isometric force against the HHD and the average of 3 trials is 
recorded for each limb.  If available ISOKINETIC CON-CON @ 60, 180, and 240 degrees/sec, 90-30 degrees of ROM. 
Timed Lateral Step down is performed on a step high enough to encourage the patient to achieve 60 degrees of knee 
flexion when the heel contacts the ground. The patient performs continuous single leg squats off the step with their 
hands on the hips to the beat of an 80 bpm metronome. Each click of the metronome signals the athlete to flex or 
extend the knee. The patient is instructed to maintain neutral limb alignment and the test is timed until the patient 
demonstrates three faulty movement pattern strikes, the patient reports pain, the inability to continue or reaches 180 
seconds. A strike includes knee valgus, loss of balance, missing the beat of the metronome or hands coming off the hips. 
The total time is recorded prior to obtaining 3 strikes for each limb.  
Hop testing is performed per standardized testing guidelines. The furthest hop is recorded to the nearest centimeter for 
each limb. Single-leg hop for distance, triple hop for distance and crossover hop for distance are measured from the 
heel. 
Lateral Leap and Catch is performed by placing two lines on the floor set at a distance of 60% of the patient’s body 
height. The patient is instructed to jump unilaterally from one foot to the other keeping to the beat of a 40 bpm 
metronome. The test is timed for 60 seconds or the test is timed until the patient demonstrates three faulty movement 
pattern strikes. A strike includes knee valgus, pelvic drop, not reaching the line or significant loss of balance.   
Y Balance Test is performed per standardized testing guidelines.  The average of 3 trials is recorded to the nearest 
centimeter for each limb. 