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Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging



To determine the prevalence of femoroacetabular impingement (FAI) of the cam or pincer type based on magnetic resonance imaging (MRI) in a group of adult female professional ballet dancers, and to quantify, in vivo, the range of motion (ROM) and congruence of the hip joint in the splits position.

Materials and methods

Institutional review board approval and informed consent from each volunteer were obtained. Thirty symptomatic or asymptomatic adult female professional ballet dancers (59 hips) and 14 asymptomatic non-dancer adult women (28 hips, control group) were included in the present study. All subjects underwent MRI in the supine position, while, for the dancers, additional images were acquired in the splits position. Labral abnormalities, cartilage lesions, and osseous abnormalities of the acetabular rim were assessed at six positions around the acetabulum. A morphological analysis, consisting of the measurement of the α angle, acetabular depth, and acetabular version, was performed. For the dancers, ROM and congruency of the hip joint in the splits position were measured.


Acetabular cartilage lesions greater than 5 mm were significantly more frequent in dancer’s hips than in control hips (28.8 vs 7.1%, p = 0.026), and were mostly present at the superior position in dancers. Distribution of labral lesions between the dancers and the control group showed substantially more pronounced labral lesions at the superior, posterosuperior, and anterosuperior positions in dancers (54 lesions in 28 dancer’s hips vs 10 lesions in 8 control hips). Herniation pits were found significantly more often (p = 0.002) in dancer’s hips (n = 31, 52.5%), 25 of them being located in a superior position. A cam-type morphology was found for one dancer and a retroverted hip was noted for one control. Femoroacetabular subluxations were observed in the splits position (mean: 2.05 mm).


The prevalence of typical FAI of the cam or pincer type was low in this selected population of professional ballet dancers. The lesions’ distribution, mostly superior, could be explained by a “pincer-like” mechanism of impingement with subluxation in relation to extreme movements performed by the dancers during their daily activities.

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  1. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.

    PubMed  Google Scholar 

  2. Pfirrmann CWA, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: Characteristic MR arthrographic findings in 50 patients. J Radiol. 2006;240(3):778–85.

    Article  Google Scholar 

  3. 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;87:1012–8.

    Article  PubMed  CAS  Google Scholar 

  4. Ito K, Minka 2nd MA, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI based quantitative anatomical study of the femoral head–neck offset. J Bone Joint Surg Br. 2001;83:171–6.

    Article  PubMed  CAS  Google Scholar 

  5. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I: Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–6.

    Article  PubMed  Google Scholar 

  6. Leunig M, Beaulé PE, Ganz R. The concept of femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:616–22.

    Article  PubMed  Google Scholar 

  7. Reynolds D, Lucac J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–8.

    Article  PubMed  CAS  Google Scholar 

  8. Wagner S, Hofstetter W, Chiquet M, et al. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis Cartilage. 2003;11:508–18.

    Article  PubMed  CAS  Google Scholar 

  9. Gilles B, Moccozet L, Magnenat-Thalmann N. Anatomical modelling of the musculoskeletal system from MRI. MICCAI '06, Part II. LNCS, Springer Berlin Heidelberg, 4190, pp. 289–296, 2006.

  10. Schmid J, Kim J, Magnenat-Thalmann N. Robust statistical shape models for MRI bone segmentation in presence of small field of view. Med Image Anal. 2011;15:155–68.

    Article  PubMed  Google Scholar 

  11. Rakhra KS, Sheikh AM, Allen D, Beaulé PE. Comparison of MRI alpha angle measurement planes in femoroacetabular impingement. Clin Orthop Relat Res. 2009;467(3):660–5.

    Article  PubMed  Google Scholar 

  12. Nötzli HP, Wyss TF, Stöcklin CH, Schmid MR, 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;84:556–60.

    Article  PubMed  Google Scholar 

  13. Wu G, Siegler S, Allard P, et al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion - part I: Ankle, hip and spine. J Biomech. 2002;35(4):543–8.

    Article  PubMed  Google Scholar 

  14. Gilles B, Kolo FC, Magnenat-Thalmann N, et al. MRI-based assessment of hip joint translations. J Biomech. 2009;42(9):1201–5.

    Article  PubMed  Google Scholar 

  15. Duthon VB, Charbonnier C, Kolo FC, et al. Correlation of clinical and MRI findings in hips of elite female ballet dancers. Arthroscopy. 2012; In Press.

  16. Charbonnier C, Kolo FC, Duthon VB, 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(3):557–66.

    Article  PubMed  Google Scholar 

  17. Charbonnier C, Kolo FC, Duthon VB et al. Professional dancer’s hip: a motion capture study. Trans Orthop Res Soc. New Orleans, Louisiana, March 2010.

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The authors declare that they have no conflict of interest.

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Correspondence to Frank C. Kolo.

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Kolo, F.C., Charbonnier, C., Pfirrmann, C.W.A. et al. Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging. Skeletal Radiol 42, 689–698 (2013).

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  • Hip
  • Early hip osteoarthritis
  • Impingements
  • Dancing
  • Ballet