Jennifer Laughridge Case Study

In the 2003 Case Study, "Linking of Injury: A Case Study of a Division I Soccer Player" by Lauran Dempsey from the University of Tennessee, she examines the injuries of UT's Women's Soccer Player, Jennifer Laughridge.

Background 

Jennifer Laughridge had suffered a number of knee injuries even before her ACL injury. During her teenage years Laughridge showed signs of Osgood-Schlatter's Disease. This is and injury that causes the Tibial Tuberosity to become enlarge due to the quadriceps muscles constantly pulling on the tubercle when the muscle contracts. However this did not limit her from her activities.

In 1996, Laughridge is 15 at the time when she sustains her first knee injury. She reported that her knee felt, "Sore and Stiff that, at one point, was able to bend her left knee." After an x-ray the physician diagnosed it as a Capsular Sprain. The x-ray didn't show any other abnormalities in her knee. 

During her Sophomore year, she experienced another left knee injury when she collided with an opponent. The x-rays didn't reveal anything while an MRI showed a avulsion of the Patellar Tendon near the Tibial Insertion. This is likely due to her early history of Osgood-Schaller's Disease. She was allowed to continue activities as pain permitted and was soon released to full activity.

In March 2000, Laughridge went down with another left knee injury in the final minute of the game. While trying to change directions, Laughridge said she heard a pop and felt sudden pain and she fell to the ground. Upon being examined, she tested a Positive Lachman's revealed a torn ACL. She opted to use a donor graft due to her history Osgood-Schlatter's Disease.

Jennifer Laughridge ACL Tear

Laughridge injury was the result of a large amount of valgus stress put on her knee when she tried to change direction. Due to the ACL connecting from the anterior, medial portion of the intercondyloid fossa of the tibia to the posterior, medial area of the lateral condyle of the femur, this valgus stress put a lot of tension on the ligament. Being that her injury occurred in the last minute of the game, fatigue was believed to be another key factor to her injury. In both Men and Women fatigue is another contributing factor to ACL Tears due to the Muscles having more laxity and don't provide as much support and protection to the ligaments.



Why Are Females Athletes Are Susceptible to ACL Tears

This Case Study proposes several reasons on why ACL Tears are more common among females than males. Dempsey refers to a study Mary Lloyd, "The Female ACL: Why is it More Prone to Injury?" In this Lloyd describes "Position of No Return" where the athlete in, "is noted to be in a relatively upright position with less flexion of the hip and knee, relatively straight back, momentum forward, and then excessive valgus at the knee." This position makes athletes very susceptible to any hyperextension or Valgus stress when running, jumping or changing directions which puts stress on the ACL.

It is also noted that athletes who hypermobile, meaning they're joints experience more flexibility in their joints, that they are more likely to suffer an ACL Tear. Women on average are more flexible and usually have that hypermobility. The probably cause to ligament laxity is believed to be due to estrogen as it's been reported that ACL injuries are more common during ovulatory phase when estrogen levels are higher.

Mechanism of Injury

Work Cited

Dempsey, Lauran J. Linking of Injury: A Case Study of a Division I Soccer Playe. University of Tennessee , 2003, trace.tennessee.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1640&context=utk_chanhonoproj. 

“Our Knowledge of Orthopaedics. Your Best Health.” Osgood-Schlatter Disease (Knee Pain) - OrthoInfo - AAOS, orthoinfo.aaos.org/en/diseases--conditions/osgood-schlatter-disease-knee-pain/.

“Anterior Cruciate Ligament (ACL) Injury.” Physiopedia, www.physio-pedia.com/Anterior_Cruciate_Ligament_(ACL)_Injury.  

 Ways to repair an ACL tear 

A. Physical Therapy :

• partial ACL tear
• option is best for people that are generally inactive; engage in moderate exercise
• recreational activities

B. Arthroscopic Surgery :

• full ACL tear
• best choice if you're an athlete that wants to continue in your sport
• if the sports consist of jumping, cutting or pivoting
• if more than 1 ligament is torn and/ or the cartilage in the knee is also injured
• patient is young and active
• if during everyday activity the knee is buckling

C. Anterior Cruciate Ligament repair :

• partial ACL tear
• minimally invasive approach
• preserves torn ACL

 How Arthroscopic Surgery Works 

• arthroscopic surgery: a surgical procedure that consist of making small incision in the patients skin and inserting straw size instrument that contains a small lens and lighting system to magnify and illuminate the joint.
• attach the arthroscope to a screen to project on a television screen for surgeon, without "opening" up the joint cavity.
• through arthroscope, surgeon can make final diagnosis.
• through arthroscopic holes surgeon can insert tools to repair ligament within the knee.

A. ACL Reconstructive Arthroscopic Surgery (Fully Torn ACL)

How it works :

• Orthopedic surgeon removes damaged ligament through arthroscopic hole 
• Damaged ligament is replaced with an ACL graft  
• Types of grafts used: allograft and autografts
• Allograft: donor tissue
• Autograft: a graft of tissue from one point to another of the same individual's body

Recovery after surgery :

• insertion sites will heal within days
• physical therapy and/or a program at a rehabilitation center may help speed up recovery and strengthen the area around the joint for better stabilization

Pros for ACL reconstructive arthroscopic surgery :

• easier on patient than "open" surgery
• patients can have as outpatient 
• home within hours after surgery 

Cons to ACL reconstruction arthroscopic surgery :

• most common complication: instrument breakage ( < 1% occurrence)
• infection
• phlebitis (blood clots within a vein)
• excessive bleeding or swelling
• damage to blood vessels or nerves

B. Anterior Cruciate Ligament Repair (For Partial Tear of ACL) :

How it works:

• suture ACL together
• place Kavlar-laced "scaffolding" around the injury site to provide additional support
• provide scaffolding for ligament to rebuild
• allows for earlier return to motion
• providing enhanced protection for ACL ligament to heal

Recovery after surgery:

• recovery time cut ing half compared to reconstructive surgery

Pros for ACL repair:

• less muscle atrophy
• faster recovery (by 1 month compared to ACL reconstructive surgery)
• preservation of nerves and blood vessels
• small pinholes into femur and tibia
• less chance of ACL failure 

Cons for ACL repair:

• not appropriate for patients with fully tone ACL

Work Cited

• "Arthroscopy," OrthoInfo American Academy of Orthopaedic Surgeons: Last Reviewed: May 2010, Contributed and/or updated by: Rick Wilkerson, DO, peer-reviewed by: Colin F. Moseley, MD

• A. Macaulay, MD, D. Perfetti, W. Levine, MD, Anterior Cruciate Ligament Graft Choices. Sports Health. 2012 Jan; 4(1): 63-68

Gross Anatomy Behind ACL Injuries

The Anterior Cruciate Ligament (ACL)

The anterior cruciate ligament (ACL) is a ligament named for the cross it forms with its counterpart, the posterior cruciate ligament (PCL). Along with two others—the medial and lateral collateral—these ligaments act as stabilizers of the knee joint. In general, ligaments are fibrous cords of dense regular connective tissue that connect bones across a joint, thereby stabilizing the joint and maintaining the bones in their proper anatomical alignment.  

What is an ACL injury ? and How do they Occur ?

Recall that the anterior cruciate ligament (ACL) is a short and sturdy ligament connecting the femur to the tibia. It runs laterally to medially, just anterior to its partner, the PCL. One of the most common knee injuries is to the ACL. 

Certain motions like twisting and pivoting predispose the ligament to sprains, and in famous cases you hear of Tiger Woods or Tom Brady, to tears. Diagnosed in more than 250,000 athletes each year, ACL injuries are increasing in frequency. A sprain is a stretching and tearing of a ligament, and tears may be partial or complete depending on the severity of the injury. 

Excessive strain to the knee joint is the major mechanism of injury. Implicated movements include:

• Torquing and twisting motions as seen in soccer, skiing.
• Valgus stress, like a football tackle to the lateral lower extremity.
• When the tibia is thrust forward while the femur is stationary, e.g. when a skier falls backwards on his skis.
• Hyperextension of the knee

ACL Tear and Reconstruction Breakdown Video

Works Cited

• “Anatomy of an Injury: ACL Injuries.” PTontheNet.com – Online Education for Fitness Professionals, www.ptonthenet.com/articles/Anatomy-of-an-Injury-ACL-Injuries-3903.

• Drdavidgeier. “ACL Injury: The Injury and Its Significance.” Dr. David Geier - Sports Medicine Simplified, Dr David Geier, 3 Mar. 2018, www.drdavidgeier.com/injury-acl-significance/.

Why Females Are More Susceptible to ACL Injuries

Why are Female Athletes More Susceptible to ACL Injuries?

Estrogen is believed to be involved in ligament laxity (lack of strictness), as it has been reported that ACL injuries occur most frequently during the ovulatory phase when estradiol (hormone estrogen) levels are highest.

Also, anatomical differences in females are involved such as the ratios of hip width to femoral length for which females have a higher ratio of. In addition, the angle between the line of the quadriceps force and the patellar ligament, females have a slight greater angle.

Now returning back to ligament laxity, females have an increased laxity in the joint, so it takes longer to sense knee joint motion while extending the knee. Most importantly, females take longer in generation of maximum hamstring force; this force supports the ACL. Core stability also contributes to the protection of the ACL, the ACL relies on the core; such as the abdomen, hip musculature, and back extensor. Males have a much stronger core compared to females.


Works Cited: Dempsey, Lauran Joy, "Linking of Injury: A Case Study of a Division I Soccer Player" (2003). University of Tennessee Honors Thesis Projects. http://trace.tennessee.edu/utk_chanhonoproj/640