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Magnetic resonance imaging findings associated with posterior ankle impingement syndrome are prevalent in elite ballet dancers and athletes

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Abstract

Objective

To report the prevalence of MRI features commonly associated with posterior ankle impingement syndrome in elite ballet dancers and athletes and to compare findings between groups.

Materials and methods

Thirty-eight professional ballet dancers (47.4% women) were age- and sex-matched to 38 elite soccer or cricket fast bowler athletes. All participants were training, playing, and performing at full workload and underwent 3.0-T standardised magnetic resonance imaging of one ankle. De-identified images were assessed by one senior musculoskeletal radiologist for findings associated with posterior ankle impingement syndrome (os trigonum, Stieda process, posterior talocrural and subtalar joint effusion-synovitis, flexor hallucis longus tendon pathology and tenosynovitis, and posterior ankle bone marrow oedema). Imaging scoring reliability testing was performed.

Results

Posterior talocrural effusion-synovitis (90.8%) and subtalar joint effusion-synovitis (93.4%) were common in both groups, as well as the presence of either an os trigonum or Stieda process (61.8%). Athletes had a higher prevalence of either os trigonum or Stieda process than dancers (74%, 50% respectively, P = 0.03). Male athletes had a higher prevalence of either os trigonum or Stieda process than male dancers (90%, 50% respectively, P = 0.01), or female athletes (56%, P = 0.02). Posterior subtalar joint effusion-synovitis size was larger in dancers than athletes (P = 0.02). Male and female dancers had similar imaging findings. There was at least moderate interobserver and intraobserver agreement for most MRI findings.

Conclusion

Imaging features associated with posterior impingement were prevalent in all groups. The high prevalence of os trigonum or Stieda process in male athletes suggests that this is a typical finding in this population.

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Acknowledgements

A sincere thank you to the dancers and athletes of The Australian Ballet, Cricket Australia, Cricket Victoria and Melbourne City Football Club for their participation in this study. The authors sincerely thank A. Kountouris of Cricket Australia for his collaborative efforts; K. Sims, N. Adcock, M. Tucker, D. Stanborough, L. Kennedy, L. Poon, and B. Robertson for assisting in participant recruitment; S. Emery, M. Hook, V. Tran, and J. Baillie for their assistance with data collection; A. Garnham, J. Walsh and T. O’Shea for their assistance in image acquisition.

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Authors and Affiliations

  1. School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, 3086, Australia

    Peta Baillie

  2. La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, 3086, Australia

    Jill Cook, Katia Ferrar & Susan Mayes

  3. The Australian Ballet, VIC, PO Box 838, South Melbourne, 3205, Australia

    Katia Ferrar, Jason Lam & Susan Mayes

  4. I-MED Radiology East Melbourne, VIC, Level 1/141 Grey Street, East Melbourne, 3002, Australia

    Peter Smith

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  1. Peta Baillie
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Correspondence to Peta Baillie.

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Baillie, P., Cook, J., Ferrar, K. et al. Magnetic resonance imaging findings associated with posterior ankle impingement syndrome are prevalent in elite ballet dancers and athletes. Skeletal Radiol 50, 2423–2431 (2021). https://doi.org/10.1007/s00256-021-03811-x

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