Radiographic Evidence of Hip Microinstability in Elite Ballet

Purpose To determine prevalence, magnitude, and predisposing radiographic features of hip subluxation in elite ballet dancers. Methods A cross-sectional investigation of professional male and female ballet dancers was performed using 5 plain radiographs. A “splits” anteroposterior (AP) radiograph was performed with legs abducted parallel to the trunk in the coronal plane (splits position; grand écart facial). Hip center position (HCP) was measured on standing AP pelvis and AP pelvis splits views and the difference calculated (subluxation distance) to determine prevalence and magnitude of femoral head subluxation. Student t test compared HCP on AP pelvis and splits radiographs. Pearson correlations were used to correlate splits HCP with radiographic measures of femoroacetabular impingement and dysplasia. Results Analyzing 47 dancers (21 men, 26 women; 23.8 ± 5.4 years), mean HCP on standing AP pelvis was 9.39 ± 3.33 mm versus 10.8 ± 2.92 mm on splits radiograph, with mean subluxation distance of 1.41 mm ( P = .035). Forty-two dancers' femoral heads translated laterally with splits positioning, and 17 dancers (36%) exhibited a “vacuum sign” (bilateral in 71% of subjects with at least 1 hip vacuum sign). There was strong positive correlation ( r = 0.461, P = .001) with splits HCP and alpha angle (Dunn 45°), and moderate negative correlation ( r = −0.332, P = .022) with subluxation distance and neck-shaft angle. In men, splits HCP increased as lateral center edge angle (CEA) decreased ( r = −0.437, P = .047), as anterior CEA decreased ( r = −0.482, P = .027), as Tönnis angle increased ( r = 0.656, P = .001), and as femoral head extrusion index increased ( r = 0.511, P = .018). In women, there was moderate negative correlation ( r = −0.389, P = .049) with subluxation distance and neck-shaft angle. Conclusions Hip subluxation occurs during splits in most professional ballet dancers, with a significantly greater magnitude of subluxation in women than men. Subluxation magnitude increases with increasing alpha angle and decreasing neck-shaft angle. In men, the magnitude increases with severity of dysplasia. Women had subluxation regardless of acetabular morphology but increased subluxation with decreased neck-shaft angle. This provides radiographic support for hip microinstability in elite ballet. Level of Evidence Level IV, diagnostic.