Is the Iliopsoas a Femoral Head Stabilizer? A Systematic Review

• Published in: Arthroscopy, Sports Medicine, and Rehabilitation Vol. 2; no. 6; pp. e847 - e853
• Main Authors: Hirase, Takashi, Mallett, Jason, Barter, Lindsay E., Dong, David, McCulloch, Patrick C., Harris, Joshua D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2020; Elsevier
• Subjects: Systematic Review
• ISSN: 2666-061X; 2666-061X
• DOI: 10.1016/j.asmr.2020.06.006

To perform a systematic review of biomechanical and clinical studies to determine whether the iliopsoas is a femoral head stabilizer.
A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Inclusion criteria were any human clinical (Levels I-IV evidence) or laboratory studies that investigated the role of the iliopsoas as a stabilizer of the hip. Exclusion criteria included studies that investigated patients undergoing spine surgery or those with a total hip arthroplasty or hip hemiarthroplasty. Study methodologic quality for clinical-outcomes studies were analyzed using the Modified Coleman Methodology Score. Because of the heterogeneity in the participants and interventions, no quantitative assimilative meta-analysis was performed.
Eight articles were analyzed (3 biomechanical [35 cadavers and 18 healthy subjects]; 5 clinical outcomes studies [537 subjects, 207 arthroscopic iliopsoas tenotomies]). Two in vivo biomechanical studies identified the iliopsoas as an anterior hip stabilizer. One cadaveric study identified the iliopsoas as a femoral head stabilizer at 0o-15o of hip flexion. Two clinical studies demonstrated the role of the iliopsoas as a dynamic hip stabilizer, particularly in patients with increased femoral version (greater than 15˚-25˚). Two studies reported cases of atraumatic anterior hip dislocations after arthroscopic iliopsoas tenotomies.
Evidence from biomechanical and clinical studies may suggest that the iliopsoas is a dynamic anterior femoral head stabilizer.
Level IV, systematic review of Level III and IV plus biomechanical studies.