Original Article| Volume 29, ISSUE 3, P411-419, March 2013

Correlation of Clinical and Magnetic Resonance Imaging Findings in Hips of Elite Female Ballet Dancers

Published:January 18, 2013DOI:


      To understand why professional female ballet dancers often complain of inguinal pain and experience early hip osteoarthritis (OA). Goals were to examine clinical and advanced imaging findings in the hips of dancers compared with those in a matched cohort of nondancers and to assess the femoral head translation in the forward split position using magnetic resonance imaging (MRI).


      Twenty professional female ballet dancers and 14 active healthy female individuals matched for age (control group) completed a questionnaire on hip pain and underwent hip examination with impingement tests and measurement of passive hip range of motion (ROM). All had a pelvic 1.5 T MRI in the back-lying position to assess femoroacetabular morphologic features and lesions. For the dancers, additional MR images were acquired in the split position to evaluate femoroacetabular congruency.


      Twelve of 20 dancers complained of groin pain only while dancing; controls were asymptomatic. Dancers' passive hip ROM was normal. No differences in α neck angle, acetabular depth, acetabular version, and femoral neck anteversion were found between dancers and controls. MRI of dancers while performing splits showed a mean femoral head subluxation of 2.05 mm. MRI of dancers' hips showed labral tears, cartilage thinning, and herniation pits, located in superior and posterosuperior positions. Lesions were the same for symptomatic and asymptomatic dancers. Controls had proportionally the same number of labral lesions but in an anterosuperior position. They also had 2 to 3 times fewer cartilage lesions and pits than did dancers.


      The results of our study are consistent with our hypothesis that repetitive extreme movements can cause femoral head subluxations and femoroacetabular abutments in female ballet dancers with normal hip morphologic features, which could result in early OA. Pathologic changes seen on MRI were symptomatic in less than two thirds of the dancers.

      Level of Evidence

      Level IV, therapeutic case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stephens R.E.
        The etiology of injuries in ballet.
        in: Dance medicine—A comprehensive guide. Pluribus, Chicago1987
        • Micheli L.J.
        Back injuries in dancers.
        Clin Sports Med. 1983; 2: 473-484
        • Miller E.H.
        • Schneider H.J.
        • Bronson J.L.
        • McLain D.
        A new consideration in athletic injuries. The classical ballet dancer.
        Clin Orthop Relat Res. 1975; 111: 181-191
        • Hardaker Jr., W.T.
        Foot and ankle injuries in classical ballet dancers.
        Orthop Clin North Am. 1989; 20: 621-627
        • Hincapie C.A.
        • Morton E.J.
        • Cassidy J.D.
        Musculoskeletal injuries and pain in dancers: a systematic review.
        Arch Phys Med Rehabil. 2008; 89: 1819-1829
        • Reid D.C.
        Prevention of hip and knee injuries in ballet dancers.
        Sports Med. 1988; 6: 295-307
        • Binningsley D.
        Tear of the acetabular labrum in an elite athlete.
        Br J Sports Med. 2003; 37: 84-88
        • Ganz R.
        • Parvizi J.
        • Beck M.
        • Leunig M.
        • Nötzli H.
        • Siebenrock K.A.
        Femoroacetabular impingement: A cause for osteoarthritis of the hip.
        Clin Orthop Relat Res. 2003; 417: 112-120
        • Beck M.
        • Kalhor M.
        • Leunig M.
        • Ganz R.
        Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip.
        J Bone Joint Surg Br. 2005; 87: 1012-1018
        • Leunig M.
        • Beck M.
        • Kalhor M.
        • Kim Y.J.
        • Werlen S.
        • Ganz R.
        Fibrocystic changes at anterosuperior femoral neck: Prevalence in hips with femoroacetabular impingement.
        Radiology. 2005; 236: 237-246
        • Sierra R.J.
        • Trousdale R.T.
        • Ganz R.
        • Leunig M.
        Hip disease in the young, active patient: Evaluation and nonarthroplasty surgical options.
        J Am Acad Orthop Surg. 2008; 16: 689-703
      1. Debrunner HU. Joint measurement (neutral-0-method) length measurement scale measurement. Bern: Bulletin der Schweizerischen Arbeitsgemeinschaft für Osteosynthesefragen, 1971 (in German).

        • Pfirrmann C.W.
        • Mengiardi B.
        • Dora C.
        • Kalberer F.
        • Zanetti M.
        • Hodler J.
        Cam and pincer femoroacetabular impingement: Characteristic MR arthrographic findings in 50 patients.
        Radiology. 2006; 240: 778-785
        • Reynolds D.
        • Lucas J.
        • Klaue K.
        Retroversion of the acetabulum. A cause of hip pain.
        J Bone Joint Surg Br. 1999; 81: 281-288
        • Notzli H.P.
        • Wyss T.F.
        • Stoecklin C.H.
        • Schmid M.R.
        • Treiber K.
        • Hodler J.
        The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.
        J Bone Joint Surg Br. 2002; 84: 556-560
        • Gilles B.
        • Kolo F.C.
        • Magnenat-Thalmann N.
        • et al.
        MRI-based assessment of hip joint translations.
        J Biomech. 2009; 42: 1201-1205
        • Gilles B.
        • Moccozet L.
        • Magnenat-Thalmann N.
        Anatomical modelling of the musculoskeletal system from MRI.
        Med Image Comput Comput Assist Interv. 2006; 9: 289-296
        • Schmid J.
        • Magnenat-Thalmann N.
        MRI bone segmentation using deformable models and shape priors.
        Springer Berlin, Heidelberg2008
        • Khan K.
        • Roberts P.
        • Nattrass C.
        • et al.
        Hip and ankle range of motion in elite classical ballet dancers and controls.
        Clin J Sport Med. 1997; 7: 174-179
        • Hamilton D.
        • Aronsen P.
        • Loken J.H.
        • et al.
        Dance training intensity at 11-14 years is associated with femoral torsion in classical ballet dancers.
        Br J Sports Med. 2006; 40: 299-303
        • Bennel K.L.
        • Khan K.M.
        • Matthews B.L.
        • Singleton C.
        Changes in hip and ankle range of motion and hip muscle strength in 8-11 year old novice female ballet dancers and controls: a 12 month follow up study.
        Br J Sports Med. 2001; 35: 54-59
        • Demarais Y.
        • Lequesne M.
        Gaz Med France. 1979; 86 (in French): 2969-2972
        • Beaulé P.E.
        • Zaragoza E.
        • Motamedi K.
        • Copelan N.
        • Dorey F.J.
        Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement.
        J Orthop Res. 2005; : 1286-1292
        • Tannast M.
        • Goricki D.
        • Beck M.
        • Murphy S.B.
        • Siebenrock K.A.
        Hip damage occurs at the zone of femoroacetabular impingement.
        Clin Orthop Relat Res. 2008; 466: 273-280
        • Safran M.R.
        • Giordano G.
        • Lindsey D.P.
        • et al.
        Strains across the acetabular labrum during hip motion: a cadaveric model.
        Am J Sports Med. 2011; 39: 92S-102S
        • Charbonnier C.
        • Kolo F.C.
        • Duthon V.B.
        • et al.
        Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study.
        Am J Sports Med. 2011; 39: 557-566
        • Smith M.V.
        • Sekiya J.K.
        Hip instability.
        Sports Med Arthrosc. 2010; 18: 108-112
        • McCormack M.
        • Briggs J.
        • Hakim A.
        • Grahame R.
        Joint laxity and the benign joint hypermobility syndrome in student and professional ballet dancers.
        J Rheumatol. 2004; 31: 173-178
        • Lindberg H.
        • Roos H.
        • Gärdsell P.
        Prevalence of coxarthrosis in former soccer players. 286 players compared with matched controls.
        Acta Orthop Scand. 1993; 64: 165-167
        • Bedi A.
        • Dolan M.
        • Leunig M.
        • Kelly B.T.
        Static and dynamic mechanical causes of hip pain.
        Arthroscopy. 2011; 27: 235-251
        • Nilsson C.
        • Leanderson J.
        • Wykman A.
        • Strender L.E.
        The injury panorama in a Swedish professional ballet company.
        Knee Surg Sports Traumatol Arthrosc. 2001; 9: 242-246