Publications by authors named "S G Bodkin"

18 Publications

Predicting ACL Reinjury from Return to Activity Assessments at 6-months Post-Surgery: A Prospective Cohort Study.

J Athl Train 2021 Jun 15. Epub 2021 Jun 15.

Department of Kinesiology. University of Virginia, Charlottesville, VA.

Context: Return to activity(RTA) assessments are commonly administered following ACL-Reconstruction(ACLR) to manage post-operative progressions back to activity. To date, there is little knowledge on the clinical utility of these assessments to predict patient outcomes such as secondary ACL injury once returned to activity.

Objective: To identify what measures of patient function at 6-months post-ACLR best predict return to activity and second ACL injury at a minimum of 2-years following ACLR.

Design: Prospective-cohort Setting: Laboratory Patients: A total of 234 patients with primary, unilateral ACLR completed functional assessments at approximately 6-months post-ACLR. A total of 192(82%) completed follow-up ≥ 2-years post ACLR.

Main Outcome Measures: Six-month functional assessments consisted of patient reported outcomes, isokinetic knee flexor and extensor strength, and single-leg hopping. The ability to return to activity and secondary ACL injury were collected at a minimum of two-years following ACLR.

Results: In patients who did RTA(n=155), a total of 44(28%) individuals had a subsequent ACL injury; graft n=24(15.5%), contralateral ACL n=20(13%). A greater proportion of females had a secondary injury to the contralateral ACL(15/24, 63%) whereas a greater proportion of males reinjured the ipsilateral ACL graft(15/20, 75%, P=.017) Greater knee extension symmetry at 6-months increased the probability of reinjury(B=.016, P=.048). In patients who RTA before 8-months, every 1% increase in quadriceps strength symmetry at 6-months increased the risk of reinjury by 2.1%(B=.021, P=.05). In patients who RTA after 8-months, every month that RTA was delayed reduced the risk of reinjury by 28.4%(B=-284, P=.042).

Conclusions: Patients with more symmetric quadriceps strength at 6-months post ACLR were more likely to experience another ACL rupture, especially in those who returned to sport earlier than 8-months after the index surgery. Clinicians should be cognizant that returning high functioning patients to activity earlier than 8-months post-ACLR may place them at an increased risk for reinjury.
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http://dx.doi.org/10.4085/1062-6050-0407.20DOI Listing
June 2021

Gaze Accuracy Differences During Single-Leg Balance Following Anterior Cruciate Ligament Reconstruction.

J Sport Rehabil 2021 Jan 27;30(5):737-743. Epub 2021 Jan 27.

Context: Individuals following anterior cruciate ligament reconstruction (ACLR) demonstrate altered postural stability and functional movement patterns. It is hypothesized that individuals following ACLR may compensate with sensory adaptations with greater reliance on visual mechanisms during activities. It is unknown if visual compensatory strategies are implemented to maintain postural stability during functional tasks.

Objective: To examine visual gaze accuracy during a single-leg balance task in individuals following ACLR compared with healthy, active controls.

Design: Case control.

Setting: Controlled laboratory.

Participants: A total of 20 individuals (10 ACLR and 10 healthy controls) participated in the study.

Data Collection And Analysis: Visual gaze patterns were obtained during 20-second single-leg balance trials while participants were instructed to look at presented targets. During the Stationary Target Task, the visual target was presented in a central location for the duration of the trial. The Moving Target Task included a visual target that randomly moved to 1 of 9 target locations for a period of 2 seconds. Targets were stratified into superior, middle, and inferior levels for the Moving Target Task.

Results: The Stationary Target Task demonstrated no differences in visual error between groups (P = .89). The Moving Target Task demonstrated a significant interaction between group and target level (F2,36 = 3.76, P = .033). Individuals following ACLR demonstrated greater visual error for the superior targets (ACLR = .70 [.44] m, healthy = .41 [.21] m, Cohen d = 0.83 [0.06 to 1.60]) and inferior targets (ACLR = .68 [.25] m, healthy = .33 [.16] m, Cohen d = 1.67 [0.81 to 2.52]).

Conclusion: Individuals following ACLR demonstrate greater visual error during settings of high or low visual stimuli compared with healthy individuals to maintain single-limb postural stability. This population may rely on visual input to compensate for the somatosensory changes following injury.
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http://dx.doi.org/10.1123/jsr.2020-0287DOI Listing
January 2021

ISB clinical biomechanics award winner 2019: Knee extensor fatigue resistance in individuals following anterior cruciate ligament reconstruction.

Clin Biomech (Bristol, Avon) 2021 01 6;81:105242. Epub 2020 Dec 6.

Department of Kinesiology, University of Virginia, Charlottesville, VA, USA.

Background: Individuals following anterior cruciate ligament reconstruction demonstrate quadriceps weakness throughout the post-operative recovery and at the time of returning to sport. This is often accompanied with patterns of quadriceps fatigue resistance. As such, fatigue may be an identifier of individuals with delayed recovery. The purpose was to assess quadriceps fatigue in anterior cruciate ligament reconstructed patients at the time of return to sport in comparison to healthy controls.

Methods: A total of 215 individuals, 120 following anterior cruciate ligament reconstruction (21.0 (2.9) years, 63 Female, 5.96 (0.48) months post-surgery) and 95 healthy controls (21.5 (8.4) years, 49 Female), participated in this study. All participants completed a 30-s knee extensor maximum voluntary isometric contraction. Knee extensor strength, limb symmetry index, and fatigue (%) were compared between groups. Between-limb fatigue comparisons were made through the Fatigue Index Limb Difference = [(Involved Limb Fatigue Index) - (Uninvolved Limb Fatigue Index)].

Findings: Individuals following anterior cruciate ligament reconstruction (18.7 (10.9)%, -5.6 (11.2)) demonstrated lower values of unilateral fatigue and Fatigue Index Limb Difference compared to healthy participants (22.5 (8.2)%, P = .002; 2.2 (7.9), P < .001). For anterior cruciate ligament reconstructed patients, there was a weak, negative, significant relationship between the involved limb strength and fatigue (r = -0.184, P = .048). There was no relationship between limb symmetry and Fatigue Index Limb Difference (r = 0.137, P = .142). For Healthy individuals, there was a positive, moderate relationship between limb symmetry and Fatigue Index Limb Difference (r = 0.400, P < .001).

Interpretation: Individuals following anterior cruciate ligament reconstruction demonstrate fatigue resistance compared to healthy active controls and greater resistance to fatigue in their involved limb compared to their contralateral limb.
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http://dx.doi.org/10.1016/j.clinbiomech.2020.105242DOI Listing
January 2021

Visuomotor therapy modulates corticospinal excitability in patients following anterior cruciate ligament reconstruction: A randomized crossover trial.

Clin Biomech (Bristol, Avon) 2021 01 20;81:105238. Epub 2020 Nov 20.

Department of Kinesiology, University of Virginia, Charlottesville, VA, USA.

Background: Corticospinal adaptations have been observed following anterior cruciate ligament reconstruction around the time of returning to activity. These measures have been related to quadriceps strength deficits. Visuomotor therapy, combining motor control tasks with visual biofeedback, has been shown to increase corticospinal excitability. The purpose of this study was to assess the immediate changes of corticospinal excitability following a single session of visuomotor therapy in patients following anterior cruciate ligament reconstruction.

Methods: This was a single blinded, sham-controlled crossover study. Ten patients following ACLR (8 Female, 26.1(6.2) years) completed assessments of quadriceps strength at approximately 4- and 6-months following anterior cruciate ligament reconstruction. At 6-months, quadriceps motor evoked potentials were assessed at 80%, 90%, 100%, 110%, 120%, 130%, 140%, and 150% of the patient's active motor threshold. Patients were randomized to receive a single session of visuomotor therapy(active) or passive motion(sham). Quadriceps motor evoked potentials were reassessed for treatment effect. Following a one-week washout period, all patients received the crossover intervention.

Findings: Moderate to large increases in motor response following visuomotor therapy 90%(P = .008, r = 0.60), 110%(P = .038, r = 0.46), 120%(P = .021, r = 0.52), 130%(P = .021, r = 0.52), 140%(P = .008, r = 0.60) and 150%(P = .021, r = 0.52) of the active motor threshold were found. Moderate increases in motor response was observed following the passive motion at 80% of the active motor threshold(P = .028, r = 0.49).

Interpretation: A single session of visuomotor therapy was found to increase quadriceps corticospinal motor response greater than the response to sham therapy. Visuomotor therapy is a potential supplement to quadriceps rehabilitation programs when upregulation of corticospinal excitability is indicated.
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http://dx.doi.org/10.1016/j.clinbiomech.2020.105238DOI Listing
January 2021

Patient function in serial assessments throughout the post-ACL reconstruction progression.

Phys Ther Sport 2021 Jan 11;47:85-90. Epub 2020 Nov 11.

Department of Kinesiology. University of Virginia, Memorial Gymnasium Rm 206 210 Emmet St So, Charlottesville, VA, 22903, USA; Department of Orthopaedic Surgery. University of Virginia, 400 Ray C. Hunt Drive, Suite 330 PO Box 800159, 22908, Charlottesville, VA, USA.

Objective: To assess the changes in patient strength and function from 4- to 6-month assessments following ACLR, determine relationships between changes in strength to changes in subjective function, and identify factors that predict patients that fail to increase in strength.

Design: Prospective, Cohort Study.

Setting: Controlled Laboratory.

Participants: Forty-seven patients(27 female, 24.3 ± 11.1 years) completed a battery of performance assessments at approximately 4- and 6-months following primary ACLR (4.03 ±0 .49 and 6.46 ±0 .68 months).

Main Outcome Measures: Subjective scores and isokinetic knee flexor and extensor strength were compared across visits. Patients were categorized per their ability to increase in strength beyond a previously defined threshold(0.22 Nm/kg). Binary logistic regression models were used to determine predictors of patients that failed to meet strength changes.

Results: Patients demonstrated improvements in patient-reported outcomes and strength measures between visits(P's < 0.05). Higher age (B = -0.073, P = .039), lower pre-injury activity levels (B = 0.61, P = .022), and higher limb symmetry indexes (B = -0.044, P = .05) at 4-months were predictors of patients that did not achieve improvements in quadriceps strength between assessments.

Conclusions: From 4- to 6-months post-ACLR, increases in subjective function, strength and symmetry were observed. High quadriceps symmetry at interim assessments without consideration of the magnitude of strength values could overestimate recovery of quadriceps function.
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http://dx.doi.org/10.1016/j.ptsp.2020.11.025DOI Listing
January 2021