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Early Signs of Osteoarthritis in Professional Ballet Dancers: A Preliminary Study

Angioi, Manuela PhD*; Maffulli, Gayle D. RGN, BA*; McCormack, Moira PT, MSc; Morrissey, Dylan PT, PhD*; Chan, Otto MBBS; Maffulli, Nicola MD, PhD*,§

Clinical Journal of Sport Medicine: September 2014 - Volume 24 - Issue 5 - p 435–437
doi: 10.1097/JSM.0000000000000035
Brief Report

Objective: To investigate a cohort of professional ballet dancers for evidence of early signs of osteoarthritis (OA).

Design: One radiologist and 1 orthopedic surgeon specialized in musculoskeletal disorders analyzed magnetic resonance imaging scans independently.

Setting: University Teaching Hospital.

Participants: Fifteen professional ballet dancers (4 males and 11 females; age range, 19-36 years) experiencing chronic pain in the hip, knee, spine, ankle, or foot joints.

Main Outcome Measures: Presence of osteophytes, subchondral sclerosis, joint space narrowing, cysts, and bone marrow changes; the Kellgren and Lawrence scale was used to quantify the knee OA.

Results: In the knee, there was thinning and irregularity of the articular cartilage over the medial femoral condyle and bone marrow changes within the lateral femoral condyle. In the hip, there was a loss of joint space and a frayed labrum with deep recess. The first metatarsophalangeal joint showed evidence of osteophytic development.

Conclusions: Early signs of OA, in different joints, were present in a small but highly selected cohort of professional ballet dancers. In future, prospective studies among a number of ballet companies should control for medical and natural history alongside the visual analysis of images and plain radiographs to confirm these preliminary results.

*Centre for Sports and Exercise Medicine, Queen Mary University of London, London, England, United Kingdom;

The Physiotherapy department, Royal Ballet Company, London, England, United Kingdom;

The Outpatient Department, London Independent Hospital, London, England, United Kingdom; and

§University of Salerno School of Medicine, Salerno, Italy.

Corresponding Author: Nicola Maffulli, MD, PhD, University of Salerno School of Medicine, Salerno, 84081, Italy (

The authors report no conflicts of interest.

Received February 15, 2013

Accepted September 12, 2013

© 2014 by Lippincott Williams & Wilkins