Abstract
BackgroundBallet 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.MethodsMR 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.ResultsBone 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.ConclusionBone 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.
Highlights
Ballet Dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle
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 [24,25,26]
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
Summary
Twelve ankles of 11 professional ballet dancers (6 female, 5 male, mean age 24 years, range 19 to 32) were MR imaged after obtaining approval from the institutional review board (IRB) at our institution. All available ballet dancers were recruited regardless of symptoms They were all actively ballet dancing without limitation; all were questioned as to whether they experienced any ankle pain at rest or during activity. Bone marrow signal was evaluated for presence of edema-type signal (high signal on STIR or fatsuppressed T2-weighted images). Bone marrow edema has been reported in association with ligament disruption [1,2,3], medial and lateral tendinopathy (in a subtendinous location) [22], and plantar fasciitis (in the calcaneus at the plantar fascia origin) [23]. Edema was recorded if focally present in association with anterior talofibular ligament tear, in a subtendinous location or at the plantar fascia origin. The plantar fascia was evaluated for internal signal or surrounding soft tissue edema on sagittal T2weighted or STIR images. Statistical analysis was performed to assess the strength of the correlation between bone marrow edema and ankle pain
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