Dancers possess a large degree of hip range of motion that results from a combination of innate and acquired osseous morphology and permissive soft tissues. Generalized hypermobil-ity in dancers may predispose them to a spectrum of hip instability. The objective of this narrative review is to discuss the anatomical characteristics, pathogenesis, risk factors, clinical signs and symptoms, management, and outcomes of hip instability treatments in dancers.
Methods
A retrospective search was performed beginning November 1, 2017, for English language articles regarding hip stability in the dancer. Key words used included but were not limited to: dance(r), ballet, hip, hypermobility, range of motion, instability, microinstability, and laxity. PubMed, Scopus, and MEDLINE databases were used.
Results
Forty-three studies were analyzed. Groin pain was found to be the most common presenting symptom of hip instability. A variety of impingement and instability signs may be elicited during physical examination. Hypermobility is frequently observed and is thought to be a necessity for participation in elite levels of ballet. Radiographs and advanced planar imaging (magnetic resonance imaging and computed tomography) should be scrutinized to evaluate for dysplasia, cam, pincer, subspine, and rotational morphologies. Dysplasia (low volume acetabulum), cam morphology, femoral retroversion, and coxa valga are common findings in the ballet dancers’ hip. Labral injuries and ligamentum teres tears are common and may potentiate instability in the hip. Management options include education, oral non-opioid medications, activity modification, exercise prescription, and surgery. Reported outcomes of these treatments in ballet are limited.
Conclusion
Hip hypermobility is prevalent in the ballet population and is a clear advantage. However, it may increase the risk of instability. It is important to identify the multifactorial osseous and soft tissue etiology of hip or groin pain in dancers. Practitioners should have a high level of suspicion for hip instability in the dancer presenting with hip pain and treat accordingly. There is a significant need for increased quantity and quality of investigation into the outcomes of treatment for hip instability in the dancer.
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References
1.
MitchellRJ, GerrieBJ, McCullochPC, . Radiographic evidence of hip microinstability in elite ballet.Arthroscopy.2016;32(6):1038–1044el.
2.
DiTullioM, WilczekL, PaulusD, . Comparison of hip rotation in female classical ballet dancers versus female nondancers.Med Probl Perform Art.1989;4(4):154–8.
3.
GannonLM, BirdHA.The quantification of joint laxity in dancers and gymnasts.J Sports Sci.1999;17(9):743–50.
4.
HarrisJD, GerrieBBJ, LintnerDM, . Microinstability of the hip and the splits radiograph.Orthopedics. 2016;39(l):el69–el75.
KalisvaartMM, SafranMR.Micro-instability of the hip—it does exist: etiology, diagnosis and treatment.J Hip Preserv Surg.2015;2(2):123–35.
7.
RoaasA, AnderssonGB.Normal range of motion of the hip, knee and ankle joints in male subjects, 30-40 years of age.Acta Orthop Scand.1982;53(2):205–8.
8.
American Academy of Orthopaedic Surgeons.Joint Motion. Method of Measuring and Recording.Edinburgh: Churchill Livingstone, 1965.
9.
BooneDC, AzenSP.Normal range of motion of joints in male subjects.J Bone Joint Surg Am.1979;61(5):756–9.
10.
RoachKE, MilesTP.Normal hip and knee active range of motion: the relationship to age.Phys Ther.1991;71(9):656–65.
11.
HallaceliH.Normal hip, knee and ankle range of motion in the Turkish population.ACTA Orthop Trauma-tol Turc.2014;48(1):37–42.
12.
KumarS, SharmaR, GulatiD, . Normal range of motion of hip and ankle in Indian population.Acta Orthop Traumatol Turc.2011;45(6):421–4.
13.
HarrisJD.Hypermobile hip syndrome.Oper Tech Sports Med.2019;27(2).
14.
DallingaJM, BenjaminseA, Lem-minkKAPM.Which screening tools can predict injury of the lower extremeties in team sports?Sport Med.2012;42(9):791–815.
15.
GriffinD, DickensonE, O'DonnellJ, . The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.Br J Sports Med.2016;50(19):1169–76.
16.
FrankJM, HarrisJD, EricksonBJ, . Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review.Arthroscopy. 2015;31(6):1199–204.
17.
KushnerS, SaboeL, ReidD, . Relationship of turnout to hip abduction in professional ballet dancers.Am J Sports Med.1990;18(3):286–91.
18.
ShermanAJ, MayallE, TaskerSL.Can a prescribed turnout conditioning program reduce the differential between passive and active turnout in pre-professional dancers?J Dance Med Sci.2014;18:159–69.
19.
McKibbinB.Anatomical factors in the stability of the hip joint in the newborn.J Bone Joint Surg.1970;52B(l):l48–59.
20.
MacintyreJ, JoyE.Foot and ankle injuries in dance.Clin Sports Med.2000;19(3):351–68.
ChampionL, ChatfieldS.Measurement of turnout in dance research—a critical review.J Dance Med Sci.2008;12(4):121–35.
23.
CooperHJ, WaltersBL, RodriguezJA.Anatomy of the hip capsule and pericapsular structures: a cadaveric study.Clin Anat.2015;28(5):665–71.
24.
LiebermanDE.The human gluteus maximus and its role in running.J Exp Biol.2006;209(ll):2l43–55.
25.
TönnisD, HeineckeA.Acetabular and femoral anteversion: relationship with osteoarthritis of the hip.J Bone Joint Surg Am.1999;81(12):1747–70.
26.
ReynoldsD, LucasJ, KlaueK.Retroversion of the acetabulum.A cause of hip pain. J Bone Joint Surg Br.1999;81(2):281–8.
27.
SkwiotM, ŚliwińskiG, MilaneseS, ŚliwińskiZ.Hypermobility of joints in dancers.PLoS One.2019;14(2):e0212188.
28.
SchmidtH, PedersenTL, JungeT, . Hypermobility in adolescent athletes: pain, functional ability, quality of life, and musculoskeletal injuries.J Orthop Sport Phys Ther.2017;47(10):792–800.
29.
DuthonVB, CharbonnierC, KoloFC, . Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers.Arthroscopy.2013;29(3):411–9.
30.
ToogoodPA, SkalakA, Cooper-manDR.Proximal femoral anatomy in the normal human population.Clin Orthop Relat Res.2009;467(4):876–85.
31.
LerchTD, TodorskiIAS, SteppacherSD, . Prevalence of femoral and acetabular version abnormalities in patients with symptomatic hip disease: a controlled study of 538 hips.Am J Sports Med.2018;46(1):122–34.
32.
WatanabeRS.Embryology of the human hip.Clin Orthop Relat Res.1974;(98):8–26.
33.
BaumanPA, SingsonR, HamiltonWG.Femoral neck anteversion in ballerinas.Clin Orthop Relat Res.1994;(302):57–63.
34.
Sutton-TrainaK, SmithJA, JarvisDN, . Exploring active and passive contributors to turnout in dancers and non-dancers.Med Probl Perform Art.2015;30(2):78–83.
35.
HamiltonD, AronsenP, LøkenJH, . Dance training intensity at 11-14 years is associated with femoral torsion in classical ballet dancers.Br J Sports Med.2006;40(4):299–303.
36.
SvenningsenS, ApalsetK, TerjesenT, AndaS.Regression of femoral anteversion: a prospective study of intoeing children.Acta Orthop Scand.1989;60(2):170–3.
37.
KoloFC, CharbonnierC, PfirrmannCWA, . Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging.26. Skeletal Radiol. 2013;42(5):689–98.
38.
PohjolaH, SayersM, MellifontR, . Three-dimensional analysis of a ballet dancer with ischial tuberosity apophysitis: a case study.J Sport Sci Med.20l4;13(4):874–80.
39.
LeunigM, NhoSJ, TurchettoL, GanzR.Protrusio acetabuli: new insights and experience with joint preservation.Clin Orthop Relat Res.2009;467(9):224l–50.
40.
VallonF, ReymondA, FürnstahlP, . Effect of angular deformities of the proximal femur on impingement-free hip range of motion in a three-dimensional rigid body model.Hip Int.2015;25(6):574–80.
41.
HarrisJD, GerrieBJ, VarnerKE, . Radiographic prevalence of dysplasia, cam, and pincer deformities in elite ballet.Am J Sports Med.2016;44(1):20–7.
42.
MayesS, FerrisAR, SmithP, . Bony morphology of the hip in professional ballet dancers compared to athletes.Eur Radiol.2017;27(7):3042–9.
43.
GanzRSlongoT, TurchettoL, . The lesser trochanter as a cause of hip impingement: pathophysiology and treatment options.Hip Int.2013;23(9 suppl):35–4l.
44.
GollwitzerH, BankeIJ, SchauweckerJ, . How to address ischiofemoral impingement? treatment algorithm and review of the literature.J Hip Preserv Surg.2017;4(4):289–98.
45.
Gómez-HoyosJ, SchröderRReddyM, . Femoral neck anteversion and lesser trochanteric retroversion in patients with ischiofemoral impingement: a case-control magnetic resonance imaging study.Arthroscopy.2016;32(1):13–8.
46.
MartinHD, SavageA, BralyBA, . The function of the hip capsular ligaments: a quantitative report.Arthroscopy.2008;24(2):188–95.
47.
van ArkelRJ, AmisAA, Cobb JP JeffersJRT.The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres: an experimental study.Bone Joint J.2015;97-B(4):484–91.
48.
HidakaE, AokiM, IzumiT, . Ligament strain on the iliofemoral, pubofemoral, and ischiofemoral ligaments in cadaver specimens: biomechanical measurement and anatomical observation.Clin Anat.20l4;27(7):1068–75.
49.
HidakaE, AokiM, MurakiT, . Evaluation of stretching position by measurement of strain on the ilio-femoral ligaments: an in vitro simulation using trans-lumbar cadaver specimens.Man Ther.2009;14(4):427–32.
50.
MyersCA, RegisterBC, LertwanichP. Role of the acetabular labrum and the iliofemoral ligament in hip stability.Am J Sports Med.2011;39(1 suppl):85–91.
51.
DevittBM, SmithBN, StapfR, . Generalized joint hypermobil-ity is predictive of hip capsular thickness.Orthop J Sport Med.2017;5(4):l–7.
52.
TanV, SeldesRM, KatzMA, . Contribution of acetabular labrum to articulating surface area and femoral head coverage in adult hip joints: an anatomic study in cadav-era.Am J Orthop (Belle Mead NJ).2001;30(11):809–12.
53.
CadetER, ChanAK, VorysGC, . Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model.Am J Sports Med.2012;40(10):2218–23.
54.
CharbonnierC, KoloFC, DuthonVB, . Assessment of congruence and impingement of the hip joint in professional ballet dancers.Am J Sports Med.2011;39(3):557–66.
55.
SafranMR, GiordanoG, LindseyDP, . Strains across the acetabular labrum during hip motion: a cadaveric model.Am J Sports Med.2011;39 Suppl(1 suppl):92S–102S.
56.
VeraA, HaghshenasV, VarnerK, . High prevalence of connective tissue gene variants in professional ballet.Presented at the International Association of Dance Medicine and Science 27th Annual Conference, 2017.
57.
MengeTJ, MitchellJJ, BriggsKK, PhilipponMJ.Anatomic arthroscopic ligamentum teres reconstruction for hip instability.Arthrose Tech.2016;5(4):e737–e742.
58.
MayesS, FerrisAR, SmithP, . Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population.Skeletal Radiol.2016;45(7):959–67.
59.
AmenabarT, O'DonnellJ.Arthroscopic ligamentum teres re-construction using semitendinosus tendon: surgical technique and an unusual outcome.Arthrose Tech.2012;l(2):el69–el74.
60.
BoykinRE, AnzAW, BushnellBD, . Hip instability. J Am Acad Orthop Surg.2011;19(6):340–9.
61.
DombBG, GiordanoBD.Atraumatic hip instability.2016;4(5):01874474–201605000-0001.
62.
ShindleMK, RanawatAS, KellyBT.diagnosis and management of traumatic and atraumatic hip instability in the athletic patient.Clin Sports Med.2006;25(2):309–26.
63.
MartinHD, KellyBT, LeunigM, . The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists.Arthroscopy. 2010;26(2):161–72.
64.
BardakosNV, VillarRN.The ligamentum teres of the adult hip.J Bone Joint Surg Br.2009;91(1):8–15.
65.
MartinHD, HatemMA, KivlanBR, MartinRL.Function of the ligamentum teres in limiting hip rotation: a cadaveric study.Arthroscopy.2014;30(9):1085–91.
66.
JacobsCL, HincapieCA, CassidyD.Musculoskeletal injuries and pain in dancers: a systematic review update.J Dance Med Sci.2012;16(2):74–84.
67.
HincapiéCA, MortonEJ, CassidyJD.Musculoskeletal injuries and pain in dancers: a systematic review.Arch Phys Med Rehabil.2008;89(9):1819–29.
68.
CerezalL, ArnaizJ, CangaA, . Emerging topics on the hip: ligamentum teres and hip microinstability.Eur J Radiol.2012;81(12):3745–54.
69.
EjnismanL, PhilipponMJ, LertwanichP.Acetabular labral tears: diagnosis, repair, and a method for labral reconstruction.Clin Sports Med.2011;30(2):317–29.
70.
ByrdJWT, JonesKS.Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients.Am J Sports Med.2004;32(7):1668–74.
71.
TorryMR, SchenkerML, MartinHD, . Neuromuscular hip biomechanics and pathology in the athlete.Clin Sports Med.2006;25(2):179–97. 60.
72.
KimYT, AzumaH.The nerve endings of the acetabular labrum.Clin Orthop Relat Res.1995;(320):176–81.
CianciA, SugimotoD, StraccioliniA, . Nonoperative management of labral tears of the hip in adolescent athletes.Clin J Sport Med.2019;29(l)24–8.
75.
MayesS, FerrisAR, SmithP, . Similar prevalence of acetabular labral tear in professional ballet dancers and sporting participants.Clin J Sport Med.2016;26(4):307–13.
76.
DyCJ, SchroderSJ, ThompsonMT, . Etiology and severity of impingement injuries of the acetabular labrum: what is the role of femoral morphology?Orthopedics.2012;35(6):e778–e784.
77.
KuhnsBD, WeberAE, LevyDM, . Capsular management in hip arthroscopy: an anatomic, biome-chanical, and technical review.Front Surg.2016;3(March):l–10.
78.
FrankJM, HarrisJD, EricksonBJ, . Prevalence of femoroacetabu-lar impingement imaging findings in asymptomatic volunteers: a systematic review.Arthroscopy.2015;31(6):1199–204.
79.
LarsonCM, RossJR, GiveansMR, . The dancer's hip: the hyperflexible athlete: anatomy and mean 3-year arthroscopic clinical outcomes.Arthroscopy.2020;36(3):725–31.
80.
WeberAE, BediA, TiborLM, . The hyperflexible hip: managing hip pain in the dancer and gymnast.Sports Health.2015;7(4):346–58.
81.
TiborLM, LeunigM.The patho-anatomy and arthroscopic management of femoroacetabular impingement.Bone Joint Res.2012;l(10):245–57.
82.
AgrícolaR, HeijboerMP, GinaiAZ, . A cam deformity is gradually acquired during skeletal maturation in adolescent and young male soccer players: a prospective study with minimum 2-year follow-up.Am J Sports Med.20l4;42(4):798–806.
83.
MayesS, FerrisAR, SmithP, . Professional ballet dancers have a similar prevalence of articular cartilage defects compared to age- and sex-matched non-dancing athletes.Clin Rheumatol.2016;35(12):3037–43.
84.
CharbonnierC, KoloFC, DuthonVB, . Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study.Am J Sports Med.2011;39(3):557–66.
85.
MalfaitF, FrancomanoC, ByersP. The 2017 international classification of the Ehlers-Danlos syndromes.Am J Med Genet Part C Semin Med Genet.2017;175(1):8–26.
86.
LarsonCM, StoneRM, GrossiEF, . Ehlers-Danlos syndrome: arthroscopic management for extreme soft-tissue hip instability.Arthroscopy.2015;31(12):2287–94.
87.
HammarstedtJE, RedmondJM, GuptaA, DombBG.Arthroscopic ligamentum teres reconstruction of the hip in Ehlers-Danlos syndrome: a case study.Hip Int.2015;25(3):286–91.
88.
SteinDA, PlatschDB, GidumalR, RoseDJ.Low-energy anterior hip dislocation in a dancer.Am J Orthop.2002;31(10):591–4.
89.
SanchesSB, OliveiraGM, Oso-rioFL, . Hypermobility and joint hypermobility syndrome in Brazilian students and teachers of ballet dance.Rheumatol Int.2015;35(4):74l–7.
90.
McCormackM, BriggsJ, HakimA, GrahameR.Joint laxity and the benign joint hypermobility syndrome in student and professional ballet dancers.J Rheumatol.2004;31(1):173–8.
91.
RuemperA, WatkinsK.Correlations between general joint hypermobility and joint hypermobility syndrome and injury in contemporary dance students.J Dance Med Sci.2012;16(4):161–6.
92.
BriggsJ, McCormackM, HakimAJ, GrahameR.Injury and joint hypermobility syndrome in ballet dancers: a 5-year follow-up.Rheumatology.2009;48(12):1613–4.
93.
FoleyEC, BirdHA.Hypermobility in dance: asset, not liability.Clin Rheumatol.2013;32(4):455–61.
94.
GrahameR, BirdHA, ChildA.The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS).J Rheumatol.2000;27(7):1777–9.
95.
BeightonP, SolomonL, SoskolneCL.Articular mobility in an African population.Ann Rheum Dis.1973;32(5):4l3–8.
96.
SimmondsJV, KeerRJ.Hypermobility and the hypermobility syndrome.ManTner.2007;12(4):298–309.
97.
BulbenaA, DuróJC, PortaM, . Clinical assessment of hypermobility of joints: assembling criteria. J Rheumatol. 1992;19(1):115–22.
98.
WyattM, WeidnerJ, PflugerD, BeckM.The femoro-epiphyseal acetabular roof (FEAR) index: a new measurement associated with instability in borderline hip dysplasia?Clin Orthop Relat Res.2017;475:861–9.
99.
van BosseH, WedgeJH, BabynP.How are dysplastic hips different? a three-dimensional CT study.Clin Orthop Relat Res.2015;473(5):1712–23.
100.
SteppacherSD, ZurmühleCA, PulsM, . Periacetabular osteotomy restores the typically excessive range of motion in dysplastic hips with a spherical head.Clin Orthop Relat Res.2015;473(4):1404–16.
101.
Hartig-AndreasenC, SoballeK, TroelsenA.The role of the acetabular labrum in hip dysplasia.Acta Orthop. 2013;84(1):60–4.
102.
GuptaA, ChandrasekaranS, RedmondJM, . Does labral size correlate with degree of acetabular dysplasia?Orthop J Sport Med.2015;3(2):l–5.
103.
SankarWN, BeaulePE, ClohisyJC, . Labral morphologic characteristics in patients with symptomatic acetabular dysplasia.Am J Sports Med.2015;43(9):2152–6.
104.
BabstD, SteppacherSD, GanzR, . The iliocapsularis muscle: an important stabilizer in the dysplastic hip.Clin Orthop Relat Res.2011;469(6):1728–34.
105.
KawaguchiAT, OtsukaNY, DelgadoED, . Magnetic resonance arthrography in children with developmental hip dysplasia.Clin Orthop Relat Res.2000;(374):235–46.
106.
YamazakiJ, MunetaT, JuYJ, . Hip acetabular dysplasia and joint laxity of female anterior cruciate ligament-injured patients.Am J Sports Med.2011;39(2):410–4.
107.
CarterC, WilkinsonJ.Persistent joint laxity and congenital dislocation of the hip.J Bone Joint Surg 96. Br.1964;46:40–5.
108.
Wynne-DaviesR.Acetabular dysplasia and familial joint laxity: two etiological factors in congenital dislocation of the hip: a review of 589 patients and their families.J Bone Joint Surg Br.1970;52(4):704–16.
109.
BilselK, CeylanHH, YıldızF, . Acetabular dysplasia may be related to global joint hyperlaxity. Int Or-thop.2016;40(5):885–9.
110.
GarbuzDS, MasriBA, Had-dadF, DuncanCP.Clinical and radiographic assessment of the young adult with symptomatic hip dysplasia.Clin Orthop Relat Res.2004;(4l8):18–22.
111.
DumontGD.Hip instability: current concepts and treatment options.Clin Sports Med.2016;35(3):435–47.
112.
KhanK, RobertsP, NattrassC, . Hip and ankle range of motion in elite classical ballet dancers and controls.Clin J Sport Med.1997;7(3):174–9.
113.
PhilipponMJ, WarthRJ, BriggsKK.Traumatic and atraumatic hip instability.In: MRI-Arthroscopy Correlations.Heidelberg: Springer, 2015, pp. 411–424.
114.
PhilipponMJ, MaxwellRB, JohnstonTL, . Clinical presentation of femoroacetabular impingement.Knee Surg Sport Traumatol Arthrosc. 2007;15(8):1041–7.
115.
KlempP, LearmonthID, LearmonthD.Hypermobility and injuries in a professional ballet company.J Sport Med.1984;18(3):l43–8.
116.
HarrisJD, GerrieBJ, VarnerKE, . Radiographic prevalence of dysplasia, cam, and pincer deformities in elite ballet. Am J Sports Med.2016;44(1):20–7.
117.
JunctionH, AokiSK.Modified false-profile radiograph of the hip provides better visualization of the anterosuperior femoral head-neck junction.Arthroscopy.2019;34(4):1236–43.
118.
HellmanMD, MascarenhasR, GuptaA, . The false-profile view may be used to identify cam morphology. Arthroscopy.2015;31(9):1728–32.
119.
Khoo-SummersL, BloomNJ.Examination and treatment of a professional ballet dancer with asuspected acetabular labral tear: a case report.Man Ther.2015;20(4):623–9.
120.
VeraAM, BarreraBD, PetersonLE, . An injury preven-tion program for professional ballet: a randomized controlled investigation.Orthop J Sport Med.2020;8(7):232596712093764.
121.
ClaytonHA, JonesSAH, HenriquesDYP.Proprioceptive precision is impaired in Ehlers-Danlos syndrome.Springerplus. 2015;4(1):1–8.
122.
PhilipponMJ, WeissDR, KuppersmithDA, . Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players.Am J Sports Med.2010;38(1):99–104.
123.
CunninghamDJ, ParanjapeCS, HarrisJD, . Advanced imaging adds little value in the diagnosis of femoroacetabular impingement syndrome.J Bone Joint Surg Am.2017;99(24):el33.
124.
BennellKL, HunterDJ, PatersonKL.Platelet-rich plasma for the management of hip and knee osteoarthritis.Curr Rheumatol Rep.2017;19(5):24.
125.
Mei-DanO, GarabekyanT, Mei-DanO.The use of platelet-rich plasma to augment conservative and surgical treatment of hip and pelvic disorders.Muscles Ligaments Tendons J.2016;6(3):4l0–9.
126.
HarrisJD, EricksonBJ, Bush-JosephCA, NhoSJ.Treatment of femoroacetabular impingement: a systematic review.Curr Rev Musculoskelet Med.2013;6(3):207–18.
127.
MinkaraAA, WestermannRW, Ros-neckJ, LynchTS.Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement.Am J Sports Med.2019;47(2):488–500.
128.
HarrisJD.Hip labral repair: options and outcomes.Curr Rev Musculoskelet Med.2016;9(4):361–7.
129.
SimpsonJM, FieldRE, VillarRN.Arthroscopic reconstruction of the ligamentum teres.Arthroscopy.2011;27(3):436–4l.
130.
GalaL, ClohisyJC, BeauléPE.Hip dysplasia in the young adult.J Bone Joint Surg Am.2016;98(1):63–73.
131.
LerchTD, EichelbergerP, BaurH, . Prevalence and diagnostic accuracy of in-toeing and out-toeing of the foot for patients with abnormal femoral torsion and femoroacetabular impingement: implications for hip arthroscopy and femoral derotation osteotomy.Bone Joint J.2019;101-B(10):1218–29.
132.
WengerDR.Surgical treatment of developmental dysplasia of the hip.Instr Course Lect.2014;63:313–23.
133.
WallPDH, FernandezM, GriffinDR, FosterNE.Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature.PM R.2013;5(5):4l8–26.
134.
EmaraK, SamirW, MotasemEH, El GhafarKA.Conservative treatment for mild femoroacetabular impingement.J Orthop Surg (Hong Kong).2011;19(l):4l–5.
135.
MoserBR.Hip pain in dancers.Curr Sports Med Rep.20l4;13(6):383–9.
136.
HartogM, SmithJ, ZujkoA.Acetabular labral tears in the dancer: a literature review.J Dance Med Sci.2006;10(1-2):51–6.
137.
BoliaI, UtsunomiyaH, LocksR, . Twenty-year systematic review of the hip pathology, risk factors, treatment, and clinical outcomes in artistic athletes-dancers, figure skaters, and gymnasts.Clin J Sport Med.2018;28(1):82–90.
138.
RussellJ.Preventing dance injuries: current perspectives.Open Access J Sport Med.2013;4:199–210.
139.
KempJL, RisbergMA, MoslerA, . Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018.Br J Sports Med.2020;54(9):504–ll.
140.
KocherMS, SolomonRLeeBM, . Arthroscopic debridement of hip labral tears in dancers.J Dance Med Sci.2006;10(3-4):99–105.
141.
LarsonCM, GiveansMR, StoneRM.Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement.Am J Sports Med.2012;40(5):1015–21.
142.
KrychAJ, ThompsonM, KnutsonZ, . Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study.Arthroscopy.2013;29(1):46–53.
143.
CetinkayaS, TokerB, OzdenVE, . Arthroscopic labral repair versus labral debridement in patients with femoroacetabular impingement: a minimum 2.5 year follow-up study.Hip Int.2016;26(1):20–4.
144.
CrawfordMJ, DyCJ, AlexanderJW, . The biomechanics of the hip labrum and the stability 133. of the hip.Clin Orthop Relat Res.2007;(465): 16–22.
145.
SafranMR.The acetabular labrum: anatomic and functional characteristics and rationale for surgical intervention.J Am Acad Orthop Surg.2010;18(6):338–45.
146.
UkwuaniGC, WatermanBR, Nwa-chukwuBU, . Return to dance and predictors of outcome after hip arthroscopy for femoroacetabular impingement syndrome.Arthroscopy.2019;35(4):1101–1108.e3.
147.
PhilipponMJ.The role of arthroscopic thermal capsulorrha-phy in the hip.Clin Sports Med.2001;20(4):817–29.
148.
LarsonCM, RossJRStoneRM, . Arthroscopic management of dysplastic hip deformities: predictors of success and failures with comparison to an arthroscopic FAI cohort.Am J Sports Med.2016;44(2):447–53.
149.
DombBG, ChaharbakhshiEO, Per-etsI, . Hip arthroscopic surgery with labral preservation and capsular plication in patients with borderline hip dysplasia: minimum 5-year patient-reported outcomes.Am J Sports Med.2018;46(2):305–13.
150.
NovaisEN, ThanacharoenpanichS, SekerA, . Do young female dancers improve symptoms and return to dancing after periacetabu-lar osteotomy for the treatment of symptomatic hip dysplasia?J Hip Preserv Surg.2018;5(2):150–6.
151.
NovaisEN, HeyworthB, MurrayK, . Physical activity level improves after periacetabular osteotomy for the treatment of symptomatic hip dysplasia.Clin Orthop Relat Res.2013;471(3):981–8.
152.
HeyworthBE, NovaisEN, MurrayK, . Return to play after periacetabular osteotomy for treatment of acetabular dysplasia in adolescent and young adult athletes.Am J Sports Med.2016;44(6):1573–81.
