Professional ballet dancers have a similar prevalence of articular cartilage defects compared to age- and sex-matched non-dancing athletes

Abstract

Ballet exposes the hip joint to repetitive loading in extreme ranges of movement and may predispose a dancer to pain and osteoarthritis (OA). The aims of this study were to compare the prevalence of cartilage defects in professional ballet dancers and athletes and to determine the relationship of clinical signs and symptoms. Forty-nine male and female, current and retired professional ballet dancers and 49 age- and sex-matched non-dancing athletes completed hip pain questionnaires, including the Copenhagen Hip and Groin Outcome Score (HAGOS), and underwent hip range of movement (ROM) testing and 3-Tesla magnetic resonance imaging to score cartilage defects (no defect, grade 1: focal partial defect and grade 2: diffuse or full thickness defect). Thirty (61 %) dancers and 27 (55 %) athletes had cartilage defects (p = 0.54). The frequency of grade 1 and 2 cartilage defects did not differ between dancers and athletes (p = 0.83). The frequency of cartilage defects was similar in male and female dancers (p = 0.34), and male and female athletes (p = 0.24). Cartilage defects were not related to history of hip pain (p = 0.34), HAGOS pain (p = 0.14), sports/rec (p = 0.15) scores or hip internal rotation ≤20° (p > 0.01). Cartilage defects were related to age in male dancers (p = 0.002). Ballet dancers do not appear to be at a greater risk of cartilage injury compared to non-dancing athletes. Male dancers develop cartilage defects at an earlier age than athletes and female dancers. Cartilage defects were not related to clinical signs and symptoms; thus, prospective studies are required to determine which cartilage defects progress to symptomatic hip OA.

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References

  1. 1.

    Brodelius Å (1961) Osteoarthrosis of the talar joints in footballers and ballet dancers. Acta Orthop Scand 30(1–4):309–314

    Article  Google Scholar 

  2. 2.

    Andersson S, Nilsson B, Hessel T, Saraste M, Noren A, Stevens-Andersson A, Rydholm D (1989) Degenerative joint disease in ballet dancers. Clin Orthop Relat Res 238:233–236

    Google Scholar 

  3. 3.

    van Dijk CN, Lim LS, Poortman A, Strubbe EH, Marti RK (1995) Degenerative joint disease in female ballet dancers. The American journal of sports medicine 23(3):295–300

    Article  PubMed  Google Scholar 

  4. 4.

    Teitz CC, Kilcoyne RF (1998) Premature osteoarthrosis in professional dancers. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 8(4):255–259

    CAS  Article  Google Scholar 

  5. 5.

    Ronkko R, Heliovaara M, Malmivaara A, Roine R, Seitsalo S, Sainio P, Kettunen J (2007) Musculoskeletal pain, disability and quality of life among retired dancers. Journal of Dance Medicine & Science 11(4):105–109

    Google Scholar 

  6. 6.

    Roemer FW, Hunter DJ, Winterstein A, Li L, Kim YJ, Cibere J, Mamisch TC, Guermazi A (2011) Hip Osteoarthritis MRI Scoring System (HOAMS): reliability and associations with radiographic and clinical findings. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 19(8):946–962

    CAS  Article  Google Scholar 

  7. 7.

    Hunter DJ, Arden N, Conaghan PG, Eckstein F, Gold G, Grainger A, Guermazi A, Harvey W, Jones G (2011) Hellio Le Graverand MP et al: definition of osteoarthritis on MRI: results of a Delphi exercise. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 19(8):963–969

    CAS  Article  Google Scholar 

  8. 8.

    Barr AJ, Campbell TM, Hopkinson D, Kingsbury SR, Bowes MA, Conaghan PG (2015) A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis. Arthritis research & therapy 17:228

    Article  Google Scholar 

  9. 9.

    Duthon VB, Charbonnier C, Kolo FC, Magnenat-Thalmann N, Becker CD, Bouvet C, Coppens E, Hoffmeyer P, Menetrey J (2013) Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 29(3):411–419

    Article  Google Scholar 

  10. 10.

    Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Feldman D, et al. (1991) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 34(5):505–514

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Ahedi HG, Aitken DA, Blizzard LC, Ding CH, Cicuttini FM, Jones G (2016) Correlates of hip cartilage defects: a cross-sectional study in older adults. J Rheumatol

  12. 12.

    L'Hermette M, Polle G, Tourny-Chollet C, Dujardin F (2006) Hip passive range of motion and frequency of radiographic hip osteoarthritis in former elite handball players. Br J Sports Med 40(1):45–49 discussion 45-49

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Cooper C, Inskip H, Croft P, Campbell L, Smith G, McLaren M, Coggon D (1998) Individual risk factors for hip osteoarthritis: obesity, hip injury, and physical activity. Am J Epidemiol 147(6):516–522

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Vingard E, Alfredsson L, Goldie I, Hogstedt C (1993) Sports and osteoarthrosis of the hip. An epidemiologic study. Am J Sports Med 21(2):195–200

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Vingard E, Alfredsson L, Malchau H (1998) Osteoarthrosis of the hip in women and its relationship to physical load from sports activities. Am J Sports Med 26(1):78–82

    CAS  PubMed  Google Scholar 

  16. 16.

    Lau EC, Cooper C, Lam D, Chan VN, Tsang KK, Sham A (2000) Factors associated with osteoarthritis of the hip and knee in Hong Kong Chinese: obesity, joint injury, and occupational activities. Am J Epidemiol 152(9):855–862

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 195(9131/03):3508–1381

    Google Scholar 

  18. 18.

    Thorborg K, Holmich P, Christensen R, Petersen J, Roos EM (2011) The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med 45(6):478–491

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Mayes S, Ferris AR, Smith P, Garnham A, Cook J (2016) Similar prevalence of acetabular labral tear in professional ballet dancers and sporting participants. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 26(4):307–313

    Article  Google Scholar 

  20. 20.

    Agricola R, Heijboer MP, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH (2013) Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis 72(6):918–923

    Article  PubMed  Google Scholar 

  21. 21.

    Wyss TF, Clark JM, Weishaupt D, Notzli HP (2007) Correlation between internal rotation and bony anatomy in the hip. Clin Orthop Relat Res 460:152–158

    PubMed  Google Scholar 

  22. 22.

    Mintz DN, Hooper T, Connell D, Buly R, Padgett DE, Potter HG (2005) Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 21(4):385–393

    Article  Google Scholar 

  23. 23.

    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Charbonnier C, Kolo FC, Duthon VB, Magnenat-Thalmann N, Becker CD, Hoffmeyer P, Menetrey J (2011) Assessment of congruence and impingement of the hip joint in professional ballet dancers a motion capture study. The American Journal of Sports Medicine 39(3):557–566

    Article  PubMed  Google Scholar 

  25. 25.

    Mitchell RJ, Gerrie BJ, McCulloch PC, Murphy AJ, Varner KE, Lintner DM, Harris JD (2016) Radiographic evidence of hip microinstability in elite ballet. Arthroscopy: The Journal of Arthroscopic & Related Surgery 32(6):1038–1044.e1

  26. 26.

    Gilles B, Christophe FK, Magnenat-Thalmann N, Becker CD, Duc SR, Menetrey J, Hoffmeyer P (2009) MRI-based assessment of hip joint translations. J Biomech 42(9):1201–1205

    Article  PubMed  Google Scholar 

  27. 27.

    Campoy FA, Coelho LR, Bastos FN, Netto Junior J, Vanderlei LC, Monteiro HL, Padovani CR, Pastre CM (2011) Investigation of risk factors and characteristics of dance injuries. Clin J Sport Med 21(6):493–498

    Article  PubMed  Google Scholar 

  28. 28.

    Kemp JL, Makdissi M, Schache AG, Pritchard MG, Pollard TC, Crossley KM (2014) Hip chondropathy at arthroscopy: prevalence and relationship to labral pathology, femoroacetabular impingement and patient-reported outcomes. Br J Sports Med 48(14):1102–1107

    Article  PubMed  Google Scholar 

  29. 29.

    Kouyoumdjian P, Coulomb R, Sanchez T, Asencio G (2012) Clinical evaluation of hip joint rotation range of motion in adults. Orthop Traumatol Surg Res 98(1):17–23

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Harris JD, Gerrie BJ, Varner KE, Lintner DM, McCulloch PC (2016) Radiographic prevalence of dysplasia, cam, and pincer deformities in elite ballet. The American journal of sports medicine 44(1):20–27

    Article  PubMed  Google Scholar 

  31. 31.

    Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ (2012) Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med 40(12):2720–2724

    Article  PubMed  Google Scholar 

  32. 32.

    Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker EA, Black KP (2011) High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med 39(4):715–721

    Article  PubMed  Google Scholar 

  33. 33.

    Farrell G, McGrath F, Hogan B, Logan M, Denvir K, O'Connell B, Irwin E, Gissane C, Wilson F (2016) 95 % prevalence of abnormality on hip MRI in elite academy level rugby union: a clinical and imaging study of hip disorders. J Sci Med Sport

  34. 34.

    Lee S, Nardo L, Kumar D, Wyatt CR, Souza RB, Lynch J, McCulloch CE, Majumdar S, Lane NE, Link TM (2015) Scoring hip osteoarthritis with MRI (SHOMRI): a whole joint osteoarthritis evaluation system. Journal of magnetic resonance imaging : JMRI 41(6):1549–1557

    Article  PubMed  Google Scholar 

  35. 35.

    Vignon E, Valat JP, Rossignol M, Avouac B, Rozenberg S, Thoumie P, Avouac J, Nordin M, Hilliquin P (2006) Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS). Joint, bone, spine : revue du rhumatisme 73(4):442–455

    Article  Google Scholar 

  36. 36.

    Bennell K, Hunter DJ, Vicenzino B (2012) Long-term effects of sport: preventing and managing OA in the athlete. Nat Rev Rheumatol 8(12):747–752

    Article  PubMed  Google Scholar 

  37. 37.

    Suri P, Morgenroth DC, Hunter DJ (2012) Epidemiology of osteoarthritis and associated comorbidities. PM R 4(5 Suppl):S10–S19

    Article  PubMed  Google Scholar 

  38. 38.

    Felson DT, Chaisson CE (1997) Understanding the relationship between body weight and osteoarthritis. Baillieres Clin Rheumatol 11(4):671–681

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Urquhart DM, Tobing JF, Hanna FS, Berry P, Wluka AE, Ding C, Cicuttini FM (2011) What is the effect of physical activity on the knee joint? A systematic review. Med Sci Sports Exerc 43(3):432–442

    Article  PubMed  Google Scholar 

  40. 40.

    Thorborg K, Branci S, Stensbirk F, Jensen J, Holmich P (2014) Copenhagen hip and groin outcome score (HAGOS) in male soccer: reference values for hip and groin injury-free players. Br J Sports Med 48(7):557–559

    Article  PubMed  Google Scholar 

  41. 41.

    Kumar D, Wyatt CR, Lee S, Nardo L, Link TM, Majumdar S, Souza RB (2013) Association of cartilage defects, and other MRI findings with pain and function in individuals with mild-moderate radiographic hip osteoarthritis and controls. Osteoarthr Cartil 21(11):1685–1692

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Hunter DJ, Zhang W, Conaghan PG, Hirko K, Menashe L, Li L, Reichmann WM, Losina E (2011) Systematic review of the concurrent and predictive validity of MRI biomarkers in OA. Osteoarthr Cartil 19(5):557–588

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Body mass index (BMI) for adults [http://www.betterhealth.vic.gov.au/bhcv2/bhcsite.nsf/pages/bmi ]

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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, P Baird-Colt, P Stellar, S Black, J Carr, J Pugh, W Tardif, G Scott, E Scase and Jan Gildea for assisting the study. Funding from the Eirene Lucas Foundation, ANZ Trustees, Friends of The Australian Ballet (SA) Inc. and the Duncan Leary Charitable Trust is gratefully acknowledged. Professor Cook was supported by the Australian Centre for Research into Sports Injury and its Prevention, which is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC). Professor Cook is a NHMRC practitioner fellow (ID 1058493).

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Correspondence to Susan Mayes.

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Ethics was approved by the Monash University Human Research Ethics Committee (MUHREC) (CF 11/3640-2011001918), and the study was conducted in accordance with the Helsinki Declaration. Participants provided written informed consent.

Conflict of interest

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

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Mayes, S., Ferris, AR., Smith, P. et al. Professional ballet dancers have a similar prevalence of articular cartilage defects compared to age- and sex-matched non-dancing athletes. Clin Rheumatol 35, 3037–3043 (2016). https://doi.org/10.1007/s10067-016-3389-4

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Keywords

  • Ballet
  • Cartilage defect
  • Hip
  • MRI
  • Osteoarthritis
  • Pain