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Incidence of Anterior Cruciate Ligament Injuries Among Elite Ballet and Modern Dancers

A 5-year Prospective Study

Marijeanne Liederbach, PhD, PT, ATC, CSCS^,*, Faye E. Dilgen, PT, DPT and Donald J. Rose, MD^,

From the Harkness Center for Dance Injuries, NYU Hospital for Joint Diseases, and the Department of Orthopaedic Surgery, NYU School of Medicine, New York, New York

^* Address correspondence to Marijeanne Liederbach, PhD, PT, ATC, CSCS, 301 East 17th Street, New York, NY 10003 (e-mail: mari-jeanne.liederbach{at}nyumc.org).

Background: Ballet and modern dance are jump-intensive activities, but little is known about the incidence of anterior cruciate ligament (ACL) injuries among dancers.

Hypothesis: Rigorous jump and balance training has been shown in some prospective studies to significantly reduce ACL injury rates among athletes. Dancers advance to the professional level only after having achieved virtuosic jump and balance technique. Therefore, dancers on the elite level may be at relatively low risk for ACL injury.

Study Design: Descriptive epidemiology study.

Methods: Dance exposure, injuries, and injury conditions were systematically recorded at 4 dance organizations over 5 years. Select neuromuscular and psychometric variables were compared between and within ACL-injured and noninjured dancers.

Results: Of 298 dancers, 12 experienced an ACL injury over the 5-year period. The incidence of ACL injury was 0.009 per 1000 exposures. Landing from a jump onto 1 leg was the mechanism of injury in 92% of cases. Incidence was not statistically different between gender or dance groups, although women modern dancers had a 3 to 5 times greater relative risk than women ballet dancers and men dancers. No difference between ACL-injured and noninjured dancers emerged with regard to race, oral contraceptive use, or select musculoskeletal measures.

Conclusion: Dancers suffer considerably fewer ACL injuries than athletes participating in team ball sports. The training dancers undertake to perfect lower extremity alignment, jump, and balance skills may serve to protect them against ACL injury. Anterior cruciate ligament injuries happened most often late in the day and season, suggesting an effect of fatigue.

Key Words: anterior cruciate ligament • incidence • gender • ballet • dance • jump • fatigue