Bone Stress Injury of the Ankle in Professional Ballet Dancers Seen on MRI
Background: Ballet Dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle. It was our objective to examine MR imaging patterns of bone marrow edema (BME) in the ankles of high performance professional ballet dancers, to evaluate clinical relevance.
Methods: MR Imaging was performed on 12 ankles of 11 active professional ballet dancers (6 female, 5 male; mean age 24 years, range 19 to 32). Individuals were imaged on a 0.2 T or 1.5 T MRI units. Images were evaluated by two musculoskeletal radiologists and one orthopaedic surgeon in consensus for location and pattern of bone marrow edema. In order to control for recognized sources of bone marrow edema, images were also reviewed for presence of osseous, ligamentous, tendinous and cartilage injuries. Statistical analysis was performed to assess the strength of the correlation between bone marrow edema and ankle pain.
Results: Bone marrow edema was seen only in the talus, and was a common finding, observed in nine of the twelve ankles imaged (75%) and was associated with pain in all cases. On fluid-sensitive sequences, bone marrow edema was ill-defined and centered in the talar neck or body, although in three cases it extended to the talar dome. No apparent gender predilection was noted. No occult stress fracture could be diagnosed. A moderately strong correlation (phi = 0.77, p= 0.0054) was found between edema and pain in the study population.
Conclusion: Bone marrow edema seems to be a specific MRI finding in the talus of professional ballet dancers, likely related to biomechanical stress reactions, due to their frequently performed unique maneuvers. Clinically, this condition may indicate a sign of a bone stress injury of the ankle.
Bone marrow edema (BME) is a common finding on magnetic resonance images (MRI) of the ankle; this finding has a wide diagnostic differential, including etiologies such as trauma, avascular necrosis, osteochondral defect, tumors and tumor-like conditions, metabolic disease, tarsal coalition, infection, arthritis, as well as tendinopathy and plantar fasciitis. Although bone marrow edema is generally associated with pathology, asymptomatic edema-type patterns related to long-distance running and altered biomechanics have been identified on MR images of the ankle in prior reports. We sought to investigate whether this effect would also be observed in a population whose occupation involves specific, repetitive lower extremity biomechanical stresses and who frequently perform full weight bearing maneuvers in extensive plantar flexion, such as on pointes and demi-pointes maneuvers.
In this study, it was our objective to look at MRI patterns of bone marrow edema in the ankles of professional high performance ballet dancers and to evaluate their clinical relevance.
Background: Ballet Dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle. It was our objective to examine MR imaging patterns of bone marrow edema (BME) in the ankles of high performance professional ballet dancers, to evaluate clinical relevance.
Methods: MR Imaging was performed on 12 ankles of 11 active professional ballet dancers (6 female, 5 male; mean age 24 years, range 19 to 32). Individuals were imaged on a 0.2 T or 1.5 T MRI units. Images were evaluated by two musculoskeletal radiologists and one orthopaedic surgeon in consensus for location and pattern of bone marrow edema. In order to control for recognized sources of bone marrow edema, images were also reviewed for presence of osseous, ligamentous, tendinous and cartilage injuries. Statistical analysis was performed to assess the strength of the correlation between bone marrow edema and ankle pain.
Results: Bone marrow edema was seen only in the talus, and was a common finding, observed in nine of the twelve ankles imaged (75%) and was associated with pain in all cases. On fluid-sensitive sequences, bone marrow edema was ill-defined and centered in the talar neck or body, although in three cases it extended to the talar dome. No apparent gender predilection was noted. No occult stress fracture could be diagnosed. A moderately strong correlation (phi = 0.77, p= 0.0054) was found between edema and pain in the study population.
Conclusion: Bone marrow edema seems to be a specific MRI finding in the talus of professional ballet dancers, likely related to biomechanical stress reactions, due to their frequently performed unique maneuvers. Clinically, this condition may indicate a sign of a bone stress injury of the ankle.
Bone marrow edema (BME) is a common finding on magnetic resonance images (MRI) of the ankle; this finding has a wide diagnostic differential, including etiologies such as trauma, avascular necrosis, osteochondral defect, tumors and tumor-like conditions, metabolic disease, tarsal coalition, infection, arthritis, as well as tendinopathy and plantar fasciitis. Although bone marrow edema is generally associated with pathology, asymptomatic edema-type patterns related to long-distance running and altered biomechanics have been identified on MR images of the ankle in prior reports. We sought to investigate whether this effect would also be observed in a population whose occupation involves specific, repetitive lower extremity biomechanical stresses and who frequently perform full weight bearing maneuvers in extensive plantar flexion, such as on pointes and demi-pointes maneuvers.
In this study, it was our objective to look at MRI patterns of bone marrow edema in the ankles of professional high performance ballet dancers and to evaluate their clinical relevance.
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