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.

What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis

“…Three studies (627 participants, 1237 hips) investigated the prevalence of hip OA in asymptomatic athletes using X-ray [54,49,60]. Four studies (40 hips) [65,52,66,67] investigated the prevalence of intra-articular hip pathologies in symptomatic athletes with MRI.…”

“…In total, 375 (28%) of the athletes were women and 960 were men. The included studies investigated different sports including American football (n=174) [62,49], soccer (n=100) [57,53], ice hockey (n=179) [64,58,59,48], ballet (n=110) [65,52,66,50,63], rugby (n=20) [55], golf (n=55) [67], skiing (n=27) [58], track and field (n=22) [56], capoeira (n=24) [51] and mixed sports (n=624) [65,52,66,61,54,60]. The level of play reported in the included studies included professional [63,65,52,66,50,59,64,61], elite [56,48,67,55,54,49,62,59], semi-professional [57], amateur or recreational [57,65,52,66,61] and youth/high school level…”

“…The level of play reported in the included studies included professional [63,65,52,66,50,59,64,61], elite [56,48,67,55,54,49,62,59], semi-professional [57], amateur or recreational [57,65,52,66,61] and youth/high school level [58,53]. Athletes participated in cutting (n=6) [57,65,52,66,58,53], flexibility (n=6) [63,50,51,65,52,66], impingement (n=4) [48,58,59,64], asymmetrical (n=5) [56,67,65,52,66] and endurance sports (n=1) [56] (Table 5). Was the sample frame a true or close representation of the target population?…”

“…Eleven studies (466 participants, 736 hips) evaluated the prevalence of cartilage defects [48,55,50,56,57,66,58,59,53,60,67]. In total, five studies analyzed prevalence per person [48,55,[57][58][59] and five studies reported prevalence per hip [50,56,53,67,60].…”

What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis

“…Two studies (two HR)48 54 reported cartilage defect prevalence per person in ice hockey players (18%)48 and high school athletes (8%) 54. Moderate evidence of a pooled cartilage defect prevalence of 33% (95% CI 16% to 56%) per hip was demonstrated from two studies (one MR and one LR)51 65 using MRI (online supplementary appendix 3 figure 2). One study (HR)54 reported a cartilage defect prevalence per hip of 4%.…”