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KneeSchool/Clinical Examination Academy/Crossover Hop

Crossover Hop

Page 4.21.4 · Functional Testing · examination page

Hopping across a line rather than along one, which is the first test in the battery to load the knee sideways.

Pipeline status. Editorial draft. Evidence verification did not run. Not consultant reviewed. Not for clinical use.

The same topic at 4 depths

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Crossover Hop

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For Medical Students

What It Tests

The crossover hop requires the patient to hop forward while crossing a line repeatedly, so it adds a lateral and rotational component to the forward hop. 4.21.3 covers the triple hop.

The examination is comparing the distance achieved on each side and watching the control during the crossing movement. 3.14.6 covers cutting manoeuvres.

It matters because most knee injuries involve a change of direction rather than a straight line effort. 3.7.14 covers injury mechanisms.

How It Is Performed

Confirm the rehabilitation stage permits lateral loading, which is later than for the forward hops. 4.2.34 covers previous rehabilitation.

Mark a straight line on the floor and ask the patient to hop forward on one leg, crossing the line with each hop.

Require each landing to be controlled, and stop the attempt if the other foot touches down or the line is missed.

Measure the total forward distance and repeat for the other side.

Watch the knee during the crossing landings, since the lateral component is where the control fails. 3.12.7 covers dynamic valgus.

Record the ratio between sides. 4.1.4 covers the structured approach.

Record pain, apprehension and refusal. 4.2.6 covers giving way.

What a Positive Means

Similar distances with controlled crossing landings is the normal result.

A disproportionate deficit on the crossover compared with the forward hops indicates a rotational control problem. 4.21.2 covers the single leg hop.

Dynamic valgus appearing only during the crossing landings is a specific finding that the forward tests miss. 3.12.7 covers dynamic valgus.

Apprehension on the lateral component after a cruciate reconstruction is common and is recorded separately. 4.22.6 covers the return to sport psychological measure.

Pain on the rotational loading localises to the structures that resist rotation. 4.10.9 covers rotational instability.

Key Learning Points

  • The test adds a lateral and rotational component.
  • Most knee injuries involve a change of direction.
  • A disproportionate deficit here is a rotational control problem.
  • Dynamic valgus during crossing is missed by the forward tests.
  • Lateral loading is permitted later in rehabilitation than forward loading.

MRCS Level

How It Is Performed

In a viva this is the part of the hop battery that justifies its existence, and the expected answer explains why.

The expected points are the rehabilitation stage, the setup with the line, the crossing requirement, the controlled landings, the measurement, the observation, the ratio and the symptoms.

Say that the lateral component is the point, and explain why a forward hop is insufficient. 3.14.6 covers cutting manoeuvres.

Say that you would permit this test later than the forward hops. 4.2.34 covers previous rehabilitation.

Say that you would watch the crossing landings specifically. 4.4.9 covers single leg landing.

What a Positive Means

The reasoning expected is that crossing the line requires the limb to accept load away from the line of progression, which loads the rotational restraints. 3.7.7 covers rotational stability.

The anterior cruciate is loaded most by a combination of valgus and rotation, which is why this test is closer to the injury mechanism than the forward hops. 3.7.13 covers loading during cutting.

Rotational control depends on the hip as well as the knee, which is why the proximal control is observed. 4.4.5 covers the Trendelenburg gait.

Confidence in rotational loading recovers later than strength after a reconstruction, which is why apprehension often limits this test specifically. 4.22.6 covers the return to sport psychological measure.

How Good It Is

The test is reproducible for distance and subjective for the control assessment, like the rest of the battery.

Its best contribution is the rotational dimension, which no other test in the battery supplies. 3.14.6 covers cutting manoeuvres.

It does not isolate a structure, and a deficit here has several causes.

No imaging corresponds to it. 4.1.6 covers that relationship.

No figures appear for any accuracy comparison on this page, under decision 023, and the comparison is the claim being made. A symmetry threshold is conventional in the literature and this repository does not state the number.

Key Learning Points

  • Crossing the line loads the limb away from the line of progression.
  • The cruciate is loaded most by valgus combined with rotation.
  • Rotational control depends on the hip as well as the knee.
  • Confidence in rotational loading recovers later than strength.
  • The rotational dimension is this test's unique contribution.

FRCS Level

How Good It Is

At decision level this is the test in the battery that most resembles the demand that injures knees.

A deficit confined to the crossover identifies a rotational control problem that the rest of the battery passes. 4.21.3 covers the triple hop.

Apprehension confined to this test identifies a confidence problem specific to rotational loading, which has its own intervention. 4.22.6 covers the return to sport psychological measure.

Pain on rotational loading after a meniscal or a cartilage procedure is a tolerance finding and changes the timetable. 4.20.2 covers the meniscal repair assessment.

The result remains one input among several in the return decision. 4.21.8 covers return to play decision making.

Where It Misleads

The commonest error is omitting this test because the forward hops were symmetrical. 4.21.2 covers the single leg hop.

Technique dominates the result, so a patient unfamiliar with the movement scores poorly for a reason that is not the knee. 4.1.4 covers the structured approach.

Distance is recorded without the control observation, which is the test's main output. 4.4.9 covers single leg landing.

A patient who avoids crossing fully is measured as if they had crossed.

Testing this before the rehabilitation stage allows it risks the healing structure. 4.2.34 covers previous rehabilitation.

Key Learning Points

  • Omitting this test because the forward hops passed is the commonest error.
  • Unfamiliarity with the movement scores as a knee deficit.
  • Distance without the control observation loses the test's main output.
  • Incomplete crossing is measured as if it were complete.
  • The rehabilitation stage governs when this test is safe.

Fellowship Level

Where It Misleads

At fellowship level the crossover hop is the battery's closest approach to the injury mechanism and still a long way from it.

The test imposes a planned change of direction and injuries happen on unplanned ones, which is the gap no field test in common use closes. 3.14.6 covers cutting manoeuvres.

Technique and familiarity contribute more to this result than to any other test in the battery, which weakens the paired comparison. 4.1.4 covers the structured approach.

Rotational control is distributed across the hip, the knee and the foot, and the test scores the outcome without locating the deficit. 4.19.7 covers torsional assessment.

A symmetrical result with a reconstructed knee does not establish that the rotational restraint is restored, since the limb compensates. 4.20.1 covers the reconstruction assessment.

The battery's thresholds and their relationship to reinjury are literature questions, and nothing here supplies a number. 4.21.8 covers return to play decision making.

Key Learning Points

  • The test imposes a planned change of direction and injuries follow unplanned ones.
  • Technique and familiarity weaken the paired comparison here most.
  • The test scores the outcome without locating the rotational deficit.
  • A symmetrical result does not establish a restored rotational restraint.
  • Thresholds and their link to reinjury are literature questions.

Explore Further

Where this topic came from and where it goes next in the spiral.

References

No reference list is attached to this draft. Evidence verification has not run, because source retrieval was unavailable at generation time. Under the Operations Handbook a missing reference is acceptable and an invented one is a critical failure, so nothing has been cited and no citation marker appears in the text. This page carries no diagnostic accuracy figure, which is decision 023 rather than an omission. The comparative standing of these tests is standard teaching and a specific sensitivity written from memory is the same class of claim as an invented citation, so ACC-001 refuses the number and the page states the comparison. A reviewer with the literature can add the figures into How Good It Is without restructuring the page, and chapter 3.17 lists the studies the figures would come from. Any measurement here, including a flexion angle, is written from standard teaching, has not been checked, and is registered under decision 006 in pipeline/config/figures with a verification state of UNVERIFIED_FROM_MEMORY.

Safety. KneeSchool is educational and does not give individual medical advice. Seek urgent assessment for a knee that cannot bear weight after an injury, a hot swollen knee with a fever, or new numbness, weakness or coldness in the leg or foot.