Anatomical variation of the Psoas Valley: a scoping review

Yuichi Kuroda,Masayoshi Saito,Vikas Khanduja,Ankit Rai

doi:10.1186/s12891-020-03241-1

Abstract

BackgroundThis scoping review aimed to investigate the literature on the anatomy of the psoas valley, an anterior depression on the acetabular rim, and propose a unified definition of the anatomical structure, describe its dimensions, anatomical variations and clinical implications.MethodsA systematic computer search of EMBASE, PubMed and Cochrane for literature related to the psoas valley was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series, case reports and review articles that described the psoas valley and its synonyms were included. Studies on animals as well as book chapters were excluded.ResultsOf the 313 articles, the filtered literature search identified 14 papers describing the psoas valley and its synonyms such as iliopsoas notch, a notch between anterior inferior iliac spine and the iliopubic eminence, Psoas-U and anterior wall depression. Most of these were cross-sectional studies that mainly analyzed normal skeletal hips. In terms of anatomical variation, 4 different configurations of the anterior acetabular rim have been identified and it was found that the curved type was the most frequent while the straight type may be nonexistent. Additionally, the psoas valley tended to be deeper in males as compared with females. Several papers established the psoas valley, or Psoas-U in a consistent location at approximately 3 o’clock on the acetabular rim which may have implications with labral pathology.ConclusionThis review highlights the importance of the anatomy of the psoas valley which is a consistent bony landmark. The anatomy and the anatomical variations of the psoas valley need to be well-appreciated by surgeons involved in the management of young adults with hip pathology and also joint replacement surgeons to ensure appropriate seating of the acetabular component.

Highlights

Iliopsoas of surgical notch technique Lee [15]10 freshfrozen cadaveric specimens Psoas-U26.9 ± 2.6 mm proximal to the tear drop (AP view) 22.9 ± 4.8 mm anterior to the center of the acetabulum (FP view) RadiographyPhilippon [4] 14 fresh- Psoas-U frozen cadaveric specimens3:30′ in o’clockface position superior-most point: 23.4 ± 2.9 mm from anterior inferior iliac spine (AIIS) center: 29.4 ± 3.4 mm from AIISCoordinatemeasuring deviceKopydlowski [3] 240 human Psoas4.64 ± 1.62 mm 26.94 ±
The complexity of acetabular architecture and biomechanics may contribute to the limited progress of anatomical studies in this area [3, 8], most health-care professionals do not have a comprehensive grasp on the psoas valley at present
A total of 313 articles were identified in the original search, and two further articles were gleaned from other sources

Summary

Introduction

Iliopsoas of surgical notch technique Lee [15]10 freshfrozen cadaveric specimens Psoas-U26.9 ± 2.6 mm proximal to the tear drop (AP view) 22.9 ± 4.8 mm anterior to the center of the acetabulum (FP view) RadiographyPhilippon [4] 14 fresh- Psoas-U frozen cadaveric specimens3:30′ in o’clockface position superior-most point: 23.4 ± 2.9 mm from AIIS center: 29.4 ± 3.4 mm from AIISCoordinatemeasuring deviceKopydlowski [3] 240 human Psoas4.64 ± 1.62 mm 26.94 ±. In performing a total hip replacement (THR), the geometric discrepancy between hemispherical implants and the native acetabular morphology including the psoas valley often results in a partial prosthetic overlap of the acetabular rim [2]. The complexity of acetabular architecture and biomechanics may contribute to the limited progress of anatomical studies in this area [3, 8], most health-care professionals do not have a comprehensive grasp on the psoas valley at present This scoping review was conducted to systematically investigate the literature on the anatomy of the psoas valley and propose a unified definition of the anatomical structure, describe its dimensions, anatomical variations and clinical implications to eventually help manage our patients better

Methods

Results

Discussion

Conclusion