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Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population

Abstract

Objectives

To compare the frequency of atraumatic ligamentum teres (LT) tear in professional ballet dancers with that of athletes, and to determine the relationship with clinical and imaging findings.

Methods

Forty-nine male and female professional ballet dancers (98 hips) and 49 age and sex-matched non-dancing athletes (98 hips) completed questionnaires on hip symptoms and physical activity levels, underwent hip rotation range of movement (ROM) and hypermobility testing, and 3.0-Tesla magnetic resonance imaging (3 T MRI) on both hips to detect LT tears, acetabular labral tears, and articular cartilage defects, and to measure the lateral centre edge angles (LCE).

Results

A higher frequency of LT tear was found in dancers (55 %) compared with athletes (22 %, P = 0.001). The frequency and severity of LT tears in dancers increased with older age (P = 0.004, P = 0.006, respectively). The Hip and Groin Outcome Score (HAGOS) pain scores or hip rotation ROM did not differ significantly among participants with normal, partial, or complete tears of LT (P > 0.01 for all). Neither the frequency of generalised joint hypermobility (P = 0.09) nor the LCE angles (P = 0.32, P = 0.16, left and right hips respectively) differed between those with and those without LT tear. In most hips, LT tear co-existed with either a labral tear or a cartilage defect, or both.

Conclusion

The higher frequency of atraumatic LT tears in professional ballet dancers suggests that the LT might be abnormally loaded in ballet, and caution is required when evaluating MRI, as LT tears may be asymptomatic. A longitudinal study of this cohort is required to determine if LT tear predisposes the hip joint to osteoarthritis.

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Acknowledgments

The authors sincerely thank the past and present dancers of The Australian Ballet who participated in the study. We thank the staff of MIA East Melbourne Radiology for their support in image acquisition. We thank S Emery for assisting in data acquisition and collation. We thank P Baird-Colt, P Stellar, S Black, J Carr, J Pugh, and W Tardif for their assistance in the collection of clinical data. We thank G Scott and E Scase for assisting in participant recruitment. Funding from the Eirene Lucas Foundation, ANZ Trustees, Friends of The Australian Ballet (SA) Inc, and the Duncan Leary Charitable Trust is gratefully acknowledged. Prof Cook was supported by the Australian Centre for Research into Sports Injury and its Prevention, which is one of the International Research Centres for the Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC). Prof Cook is a NHMRC practitioner fellow (ID 1058493).

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Correspondence to Susan Mayes.

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Susan Mayes is employed by The Australian Ballet and declares a potential conflict of interest. The other authors declare that they have no conflicts of interest.

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Mayes, S., Ferris, AR., Smith, P. et al. Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population. Skeletal Radiol 45, 959–967 (2016). https://doi.org/10.1007/s00256-016-2379-6

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  • DOI: https://doi.org/10.1007/s00256-016-2379-6

Keywords

  • Hip joint
  • Ligamentum teres
  • Magnetic resonance imaging
  • Ballet
  • Lateral centre edge angle
  • Hypermobility