Anterior cruciate ligament rupture in professional ballet dancers, follow-up care and return to full workload without restrictions

Ballet is an art that requires absolute physical control, strength, flexibility, and repetitive loading of joint structures in extreme positions. Outwardly appearing easy and graceful, it is in fact a physically extremely demanding discipline. Despite the growing body of knowledge in the field of sports physiotherapy, the specific demands that the profession of classical ballet places on physiotherapy care following surgical procedures such as anterior cruciate ligament reconstruction often remain overlooked in clinical thinking. This article focuses on the specifics of physiotherapy following anterior cruciate ligament (ACL) reconstruction in professional classical ballet dancers. Particular attention is required for the so-called en dehors (dialed) position, which is characterized by the position of the lower limbs in maximal external rotation. The ideal range of the spin in ballet is up to 180 degrees. Although this movement originates primarily from the hip joint (60%) the remaining 40% is completed by the knee and ankle joints. This movement represents a significant biomechanical load, particularly in the knee joint, which is often secondarily overloaded and vulnerable when rotation is not adequately controlled. In this article, we address the issue of incorporating early rotation control into the physiotherapy process after ACL surgery, highlighting the principles that must be strictly adhered to when restoring external rotation in order to prevent re-injury to the ligamentous apparatus of the knee. Proper timing, movement control, and respect for biomechanical limits are key to a safe return to the specific movement patterns of ballet. This paper highlights the need for an individualized approach and a deeper understanding of the biomechanics of ballet movement within sports medicine and physiotherapy.