Relationship of Patellofemoral Angles and Tibiofemoral Rotational Angles With Jumper's Knee in Professional Dancers: An MRI Analysis.

BACKGROUND: Jumper's knee is a type of tendinopathy affecting the distal insertion of the quadriceps tendon (25% of cases) or the patellar tendon. It has been shown that frontal-plane measurements, such as genu valgum, genu varum, an increased quadriceps angle, a protuberant tibial tuberosity, patella alta, and short hamstring muscles, may be related to jumper's knee. PURPOSE: To investigate the effects of tibiofemoral rotational angles and patellofemoral (PF) angles on the development of jumper's knee in professional folk dancers. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We examined 26 dancers (16 male, 10 female) with knee pain using magnetic resonance imaging (MRI), for a total of 32 knees. Of the knees, 21 with quadriceps tendinopathy (QT) and 7 with patellar tendinopathy (PT) were detected. Using MRI scans, we measured PF angles (PF sulcus angle, lateral PF angle, patellar tilt angle, lateral trochlear inclination angle, lateral patellar tilt angle, and PF congruence angle) and tibiofemoral rotational angles (condylar twist angle, posterior condylar angle, femoral Insall angle, tibial Insall angle, posterior tibiofemoral angle, and angle between the Whiteside line and posterior femoral condylar line) and noted specifics such as patella alta, patella baja, and the Wiberg classification of the patellar shape between the patients with versus without QT and between patients with versus without PT to understand if there was any relationship with tendinopathy. RESULTS: No statistically significant difference was observed in age, sex, patella alta, or the Wiberg classification between the QT groups (with vs without) and between the PT groups (with vs without) (P > .05). Having QT was found to be significantly associated with the PF sulcus angle (P = .009), and having PT was found to be significantly associated with the femoral Insall angle (P = .029). CONCLUSION: Jumper's knee was found to be associated with anatomic variations of the PF sulcus angle and rotation of the patellar tendon in relation to the femur (femoral Insall angle) on axial MRI scans in professional dancers. Unlike those of other athletes, dancers' knees are exposed more to external rotation forces because of turnout, and this can be the cause of jumper's knee.

Patellofemoral Chondropathy Areas in Folk Dancers: An MRI Study.

BACKGROUND: Patellofemoral chondropathy (PFC) is one of the most important causes of patellofemoral pain syndrome. PFC may occur as a result of anatomic reasons such as patellar malalignment and/or increased patellofemoral joint stresses. Most research on this subject has involved sports injuries and anatomic variations. The literature is scarce on PFC related to the dance. METHODS: Fourteen dancers (14 knees, all male) were found to have PFC based on MRI evaluations and clinical examinations between January 2010 and December 2019 (3 dancers were excluded due to prior surgeries of the knee). Age, sex, side of injury, range of motion, Q angle, types of dances, body mass index, and patellar specifics (alta, baja, Wiberg) were recorded for 11 dancers included in the study. We observed PFC at the femoral contact areas (FCA) and patellar contact areas (PCA) of Goodfellow description. RESULTS: Chondral lesions were observed at Gooodfellow areas FCA-3 in 2 dancers, FCA-4 in 5 dancers, PCA-2 in 10 dancers, PCA-3 in 10 dancers, and PCA-4 in 9 dancers. CONCLUSION: Dance styles that include frequent deep flexions and strolling on a flexed knee joint may be risk factors for chondral lesions in the contact area of the femur in male dancers.

Traumatic knee injury patterns in Anatolian folk dancers: a case series and literature review.

Lower extremities, especially the knee region, are susceptible to traumatic injuries because of long-lasting hard landings and impacts. Most of the injuries described in the literature are associated with ballet. In this review study, the authors tried to present the traumatic knee injury patterns of the Anatolian folk dance. The Fire of Anatolia dance group consists of 82 dancers (37 males [45.1%] and 45 females [54.9%]) with the mean age of 27.96 (SD = 5.05) years (range: 18-38 years). The major folk dances of the region are Zeybek, Halay, Horon, Teke, Roman, Karsilama, Bar and Lezginka ("the Caucasian"). The dancers suffered from 9 orthopedic injuries requiring surgical treatment (3 meniscus tears, 4 anterior cruciate ligament tears, 1 posterior cruciate ligament tear, 1 patellar dislocation) during a 10-year period. The authors investigated solely the traumatic injuries of these folk dance styles and aimed at revealing the traumatic knee injury patterns in this case series and literature review. On the one hand, the Anatolian folk dancers experienced meniscus tears following frequent squats and twists on single leg stances, typical of Horon and Zeybek. On the other hand, anterior cruciate tears happened after jumps and landings in the Caucasian (Lezginka jump) dance. A posterior cruciate ligament tear was also seen after the Caucasian dance landing. The split figure in the Karsilama dance ended up with patellar dislocation. Certain dance figures seem to be related to specific types of injuries. Int J Occup Med Environ Health. 2019;32(5):585-93.

Relationship of Popliteus Sulcus Depth and Tibiofemoral Rotational Alignment with Popliteus Tendinitis in Professional Folk Dancers Exposed to Turnout Positions: An MRI Analysis.

AIMS: The popliteus musculotendinous unit plays the major role in range of motion, rotation and stabilization of the knee. Frequent repetition of the rotational strains such as turnout in dancers may be the cause of popliteus tendinitis. In addition, popliteus sulcus depth (PSD) and PSD/lateral condyle width (LCW) ratio are also highly related with popliteal tendinitis in professional folk dancers. In this study, we evaluated the association between clinically diagnosed popliteus tendinitis and PSD with analysis of the PSD/LCW ratio as measured on MRI and tibiofemoral rotational alignment in professional folk dancers. This study was intended to clarify any anatomical liability to popliteal tendinitis in professional folk dancers. Therefore, we looked for the anatomical variances affecting popliteal musculotendinous unit. METHODS: Thirty-two MRI scans from 32 members of a professional folk dance group (mean age 30.2±7.9 yrs, range 18-38) were analyzed retrospectively. Popliteal tendinitis was detected in 5 knees (5 dancers). The relationship of popliteal tendinitis to the tibiofemoral rotational angles (condilary twist angle, posterior codilary angle, posterior tibiofemoral angle), PSD, and PSD/LCW ratio were investigated. RESULTS: The popliteus tendinitis group had statistically significantly higher PSD and PSD/LCW ratio than the group without popliteal tendinitis (p=0.0001). There was no statistically significant difference between the two groups in the tibiofemoral rotational angles. CONCLUSION: In addition to long hours of practice and the turnout position, PSD and PSD/LCW ratio can place the professional folk dancer at increased risk for popliteus tendon injury.

Overuse Injuries in Professional Anatolian Folk Dancers: A Descriptive Study Verified with MRI.

BACKGROUND: Professional dancers are artists as well as athletes who push their bodies beyond limits for aesthetic expression. Therefore, overuse injuries are common. We present our findings on overuse injuries in Anatolian (Turkish) folk dancers. METHODS: The Fire of Anatolia dance group comprises of 82 dancers (37 male, 45 female) with a mean age of 27.96±5.05 yrs (range 18 to 38). Forty-one dancers from this group presented to our clinic between February 2009 and April 2016 with complaints of pain, and 25 of them had magnetic resonance imaging (MRI) for verification. The type, frequency, and anatomical locations of their overuse injuries as found on MRI were investigated. RESULTS: We evaluated a total of 70 overuse injuries in 25 dancers. All injuries were seen on separate occasions, and multiple injuries in the same dancers at separate times were recorded. Most of the overuse injuries were seen around the knee joint. Ankle ligament injuries were not seen in our study, in contrast to ballet and modern dance. Overuse injuries were observed in the knee in 68% of cases, thigh in 24%, lumbar region in 24%, feet in 20%, shoulder in 16%, and hip in 12%. CONCLUSIONS: Overuse injuries occur mostly in the knee region in Anatolian folk dancers. There were no statistically significant differences between dancers with and without overuse injuries in terms of age, sex, and dance style (p>0.05).