title: Lower Extremity Injury Patterns in Elite Ballet Dancers: Ultrasound/MRI Imaging Features and an Institutional Overview of Therapeutic Ultrasound Guided Percutaneous Interventions.
abstract: BACKGROUND
  Altered biomechanics from repetitive microtrauma, such as long practice hours in en pointe (tip of the toes) or demi pointe (balls of the feet) predispose ballet dancers to a multitude of musculoskeletal pathologies particularly in the lower extremities. Both ultrasound and magnetic resonance imaging (MRI) are radiation-sparing modalities which can be used to confidently evaluate these injuries, with ultrasound (US) offering the added utility of therapeutic intervention at the same time in experienced hands.
  
  
  OBJECTIVE
  The purposes of this paper were: (1) to illustrate the US and MRI features of lower extremity injury patterns in ballet dancers, focusing on pathologies commonly encountered at a single orthopedic hospital; (2) to present complementary roles of both ultrasound and MRI in the evaluation of these injuries whenever possible; (3) to review and present our institutional approach towards therapeutic ultrasound-guided interventions by presenting explicit cases.
  
  
  METHODS
  Online searches were performed using the search criteria of "ballet biomechanics" and "ballet injuries." The results were then further narrowed down by limiting articles published in the past 15 years, modality (US and MRI), anatomical region (foot and ankle, hip and knee) and to major radiology, orthopedics, and sports medicine journals.
  
  
  RESULTS
  Performing ballet poses major stress to lower extremities and predisposes dancer to several musculoskeletal injuries. These can be adequately evaluated by both US and MRI. US is useful for evaluating superficial structures such as soft tissues, tendons, and ligaments, particularly in the foot and ankle. MRI provides superior resolution of deeper structures such as joints, bone marrow, and cartilage. In addition, US can be used as a therapeutic tool for providing quick symptomatic improvement in these athletes for who "time is money".
  
  
  CONCLUSIONS
  Performing ballet may cause major stress to the lower extremities, predominantly affecting the foot and ankle, followed by the knee and hip. US and MRI play complementary roles in evaluating various orthopedic conditions in ballet dancers, with US allowing for dynamic evaluation and guidance for interventions.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Razia
authors.identifier: 0000-0002-6261-5305
authors.initials: R
authors.lastname: Rehmani
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Endo
authors.affiliation: Orthopedic Associates of New York, 315 West 57th Street, New York, NY 10019 USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Bauman
authors.affiliation: Orthopedic Associates of New York, 315 West 57th Street, New York, NY 10019 USA.
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Hollis
authors.initials: H
authors.lastname: Potter
authors.affiliation: Hospital for Joint Diseases, New York University, New York, NY USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Adler
keywords: MRI; ballet; corticosteroid and PRP; foot and ankle; hip; labrum; ligament; osseous; tendon; ultrasound