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


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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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).

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