Distal Insertions of the Biceps Femoris

Abstract

Background:Avulsion of the biceps femoris from the fibula and proximal tibia is encountered in clinical practice. While the anatomy of the primary posterolateral corner structures has been qualitatively and quantitatively described, a quantitative analysis regarding the insertions of the biceps femoris on the fibula and proximal tibia is lacking.Purpose:To quantitatively assess the insertions of the biceps femoris, fibular collateral ligament (FCL), and anterolateral ligament (ALL) on the fibula and proximal tibia as well as establish relationships among these structures and to pertinent surgical anatomy.Study Design:Descriptive laboratory study.Methods:Dissections were performed on 12 nonpaired, fresh-frozen cadaveric specimens identifying the biceps femoris, FCL, and ALL, and their insertions on the proximal tibia and fibula. The footprint areas, orientations, and distances from relevant osseous landmarks were measured using a 3-dimensional coordinate measurement device.Results:Dissection produced 6 easily identifiable and reproducible anatomic footprints. Tibial footprints included the insertion of the ALL and an insertion of the biceps femoris (TBF). Fibular footprints included the insertion of the FCL, a distal insertion of the biceps femoris (DBF), a medial footprint of the biceps femoris (MBF), and a proximal footprint of the biceps femoris (PBF). The mean area of these footprints (95% CI) was as follows: ALL, 53.0 mm2 (38.4-67.6); TBF, 93.9 mm2 (72.0-115.8); FCL, 86.8 mm2 (72.3-101.2); DBF, 119 mm2 (91.1-146.9); MBF, 46.8 mm2 (29.0-64.5); and PBF, 215 mm2 (192.4-237.5). The mean distance (95% CI) from the Gerdy tubercle to the center of the ALL footprint was 24.3 mm (21.6-27.0) and to the center of the TBF was 22.5 mm (21.0-24.0). The center of the DBF was 8.68 mm (7.0-10.3) from the anterior border of the fibula, the center of the FCL was 14.6 mm (12.5-16.7) from the anterior border of the fibula and 20.7 mm (19.0-22.4) from the tip of the fibular styloid, and the center of the PBF was 8.96 mm (8.2-9.7) from the tip of the fibular styloid.Conclusion:A tibial footprint, distal fibular footprint, medial fibular footprint, and proximal fibular footprint were all consistent components of the insertion of the biceps femoris. Consistent relationships existed between the biceps femoris and insertions of the ALL and FCL.Clinical Relevance:The size of these footprints and distances from pertinent surgical landmarks will guide repairs of biceps femoris avulsion injuries.

Isolated Tearing and Avulsion of the Distal Biceps Femoris Tendon During Sporting Activities: A Systematic Review

“… 16 , 31 The short head component, originating from the linea aspera on the posterior aspect of the femoral diaphysis, converges and coalesces with the tendon of the long head of the biceps femoris (originating from the ischial tuberosity) in the posterolateral aspect of the distal half of the thigh. 6 , 31 In their study of 30 cadaveric knees, Terry and LaPrade 31 provided detailed anatomic descriptions of the tendinous insertions of the distal biceps femoris. The authors reported that the tendinous insertion of the long head includes a direct arm inserting on the posterolateral aspect of the proximal fibula and an anterior arm inserting along the lateral edge of the proximal fibula, lateral to the fibular collateral ligament (FCL) and distally along the anterior aponeurosis in the anterior compartment of the leg.…”

Current Concepts of the Anterolateral Ligament of the Knee: Anatomy, Biomechanics, and Reconstruction

“…35 At the tibia, the ALL has an average attachment area of 53.0 to 64.9 mm 2 and attaches an average of 24.7 mm posterior to the center of Gerdy's tubercle and 26.1 mm proximal to the anterior margin of the fibular head. 8,31 The tibial insertion site of the ALL can be found an average of 9.5 mm distal to the joint line and just proximal to the tibial insertion of the biceps femoris. 8,31 BIOMECHANICS Several studies have tested the biomechanical properties of the ALL, with a mean ultimate load to failure measured between 50 and 205 N, a mean stiffness of 20 to 42 N/mm, and a mean ultimate strain of 36%.…”

Snapping Biceps Femoris: clinical demonstration and operative technique

“…A quantitative analysis of distal insertions of the biceps femoris in 2015 identified tibial, distal fibular, medial fibular and proximal fibular footprints as consistent components of the insertion of the biceps femoris. 12 While snapping biceps femoris syndrome is a recognised entity in the literature, it remains an uncommon cause of lateral knee pain with only few case reports and small series published, leaving treating clinicians with little evidence to guide their management. [4][5][6][7][8][9][10][13][14][15][16][17] Most, however, agree on the need for surgical intervention once all non-operative measures have failed to relieve the painful symptomatic snapping.…”