Triple Hop

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Student MRCS FRCS Fellow

For Medical Students

What It Tests

The triple hop tests force production and absorption three times in succession, so it adds the ability to reload after a landing. 4.21.2 covers the single leg hop.

The examination is comparing the total distance across three hops on each side, and watching whether the control degrades. 4.4.9 covers single leg landing.

It matters because a knee can manage one landing and lose control on the second, which is closer to what sport demands. 3.14.7 covers jumping.

How It Is Performed

Confirm the rehabilitation stage permits repeated hopping. 4.2.34 covers previous rehabilitation.

Mark a starting line and ask for three consecutive forward hops on one leg, landing on the same leg each time.

Require each landing to be controlled, and stop the attempt if the patient puts the other foot down.

Measure the total distance from the line to the final heel position, and repeat for the other side.

Watch the second and third landings in particular, since that is where the control degrades. 3.12.7 covers dynamic valgus.

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

Record any pain, apprehension or refusal. 4.2.6 covers giving way.

What a Positive Means

Similar total distances with controlled landings throughout is the normal result.

A result that starts well and degrades across the three hops indicates a reloading or an endurance deficit rather than a strength one. 4.3.9 covers muscle wasting.

A shorter total distance with consistent control indicates a force production deficit. 4.21.2 covers the single leg hop.

Deteriorating knee position across the hops indicates a control deficit that a single hop would have missed. 3.12.7 covers dynamic valgus.

Pain appearing on the later hops rather than the first localises a loading tolerance problem. 4.7.6 covers the painful arc.

Key Learning Points

The test adds the ability to reload after a landing.
The second and third landings are where control degrades.
A degrading result is an endurance finding rather than a strength one.
A short result with good control is a force production finding.
Pain appearing late indicates a loading tolerance problem.

MRCS Level

How It Is Performed

In a viva this belongs in the hop battery answer and the expected version explains what the repetition adds.

The expected points are the rehabilitation stage, the setup, the controlled landing requirement, the total distance, the observation of the later landings, the ratio and the symptoms.

Say that the repetition is the point, and explain why a single hop is insufficient. 4.21.2 covers the single leg hop.

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

Say that this test is one of a battery rather than a standalone criterion. 4.21.7 covers return to sport testing.

What a Positive Means

The reasoning expected is that each landing requires eccentric absorption followed immediately by concentric production, so the test measures the transition between them. 3.14.8 covers landing.

Fatigue over three hops exposes a deficit that a single effort conceals, which is why the battery includes repeated tests. 3.14.7 covers jumping.

Control deteriorating under fatigue is the pattern associated with injury mechanisms, which is why the later landings matter most. 3.7.14 covers injury mechanisms.

Quadriceps endurance rather than peak strength governs the later hops, which is why the two deficits separate here. 4.3.9 covers muscle wasting.

How Good It Is

The test is reproducible for total distance and subjective for the control assessment.

Its best contribution is exposing fatigue related deterioration, which the single hop misses. 4.21.2 covers the single leg hop.

It does not isolate a structure and measures the limb.

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

Each landing requires absorption then immediate production.
Fatigue over three hops exposes what a single effort conceals.
Control deteriorating under fatigue is the injury associated pattern.
Endurance rather than peak strength governs the later hops.
The test's contribution is the fatigue related deterioration.

FRCS Level

How Good It Is

At decision level the triple hop adds the endurance dimension to the return to sport assessment.

A symmetrical single hop with a degrading triple hop identifies an endurance deficit that would otherwise pass. 4.21.2 covers the single leg hop.

Deteriorating control under fatigue is a rehabilitation target rather than a structural finding, and the distinction decides the intervention. 4.21.7 covers return to sport testing.

Pain appearing only on repetition suggests a loading tolerance problem in a cartilage or a tendon structure. 4.17.5 covers articular cartilage defects.

The result is one input among several, so it does not by itself permit or prevent return. 4.21.8 covers return to play decision making.

Where It Misleads

The commonest error is recording total distance only, so degrading control is invisible. 4.4.9 covers single leg landing.

Three hops is a small amount of fatigue compared with a match, so the test underestimates the deficit. 3.15.1 covers the demands of football.

Technique improves with practice within the session, which inflates the second side tested. 4.1.4 covers the structured approach.

A patient who stops because of apprehension is recorded as having an endurance deficit. 4.22.6 covers the return to sport psychological measure.

The unaffected side is assumed to represent the patient's capacity, which after a long rehabilitation it does not. 4.3.9 covers muscle wasting.

Key Learning Points

Total distance alone hides degrading control.
Three hops is a small amount of fatigue compared with a match.
Within session practice inflates the second side tested.
Apprehension is recorded as an endurance deficit.
The unaffected side may not represent the patient's capacity.

Fellowship Level

Where It Misleads

At fellowship level the triple hop's value is the fatigue dimension and its weakness is how little fatigue it actually imposes.

The test imposes seconds of effort against a sport that imposes an hour, so it samples the fatigue axis rather than testing it. 3.15.1 covers the demands of football.

Total distance can mask an asymmetric distribution across the three hops, which is where the information sits. 4.21.2 covers the single leg hop.

Control is graded by observation under time pressure, which makes it the least reliable part of a test valued for exactly that part. 4.4.9 covers single leg landing.

Learning within the session is a systematic bias in a paired comparison, and alternating the order mitigates it rather than removing it. 4.1.4 covers the structured approach.

A battery of tests measures what the battery measures, and its relationship to reinjury is a literature question this repository cannot answer. 4.21.8 covers return to play decision making.

Key Learning Points

The test samples the fatigue axis rather than testing it.
Total distance masks the distribution across the three hops.
Observational control grading is the least reliable part of the test.
Within session learning is a systematic bias in a paired comparison.
The battery's relationship to reinjury is a literature question.

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.