Surgical Repair of Dynamic Snapping Biceps Femoris Tendon

Abstract

A snapping biceps tendon is an infrequently seen and commonly misdiagnosed pathology, leaving patients with persistent symptoms that can be debilitating. Patients will present with a visible, audible, and/or painful snap over the lateral aspect of their knee when performing squats, sitting in low seats, or participating in activities with deep knee flexion. A thorough knowledge of the anatomy is essential for surgical treatment of this pathology, which is caused by a detachment of the direct arms of the long and short heads of the biceps femoris off the fibular styloid. This Technical Note provides a diagnostic approach, postoperative management, and details of a surgical technique to treat a snapping biceps tendon with an anatomic repair of the long and short head attachments of the biceps femoris to the posterolateral fibular styloid.

Painful Unilateral Knee Snapping after Hyperextension Injury and Meniscus Tear

“…Pain and snapping from the biceps femoris insertion can be due to anomalous anatomy of the insertion itself, dysmorphia of the fibular head or from trauma. 3 10 11 12 13 14 Saltzman et al also reported that the popliteus tendon, lateral collateral ligament, and iliotibial band can cause a popping sensation and snapping at the lateral knee. 15…”

Biceps Femoris Tendon Subluxation Snapping Knee, Treated by a Modified Kennedy Procedure: A Case Report

“…Several previous case reports described this phenomenon. Biceps femoris tendon syndrome has been found to be due to anomalous insertion of the long head of the biceps femoris tendon [ 1 , 3 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ], fibular head deformity [ 15 , 16 , 17 , 18 ], tendon injury [ 19 , 20 ], and normal anatomy without trauma [ 21 , 22 ].…”

“…Bagchi and Grelsamer and Kristen et al described abnormal anterior insertion on proximal tibia treated by partial fibular head resection. [ 7 , 9 ] Date et al, Matar and Farrar, Kissenberth and Wilckens, Kennedy et al, and Reid and Mofidi described abnormal insertion of the biceps femoris treated by release and reinsertion of the tendon in the fibular head [ 3 , 8 , 11 , 13 , 14 ]. Ernat and Galvin described abnormal anterior insertion on proximal tibia and thickened anterolateral fibular insertion treated only with release of the abnormal tendon insertion [ 10 ].…”

“…Only the superior portion of the tendon was subluxating over the fibular head. Our surgical procedure was a modification of Kennedy’s technique [ 13 ]. It included no tendon release with rerouting of the superior portion to a position inferior to the fibular head using one anchor seated 1 cm inferior to the tip of the styloid and on the posterolateral portion of the fibula.…”

Multiple ligament anatomic-based reconstructions of the knee: State- of-the-art

“…CPN neurolysis, including 5-7 mm of release of the peroneus longus fascia overlying the nerve, is usually performed to minimize trauma to the nerve caused by swelling and stretching. [59]…”