Partial Fibular Head Resection Technique for Snapping Biceps Femoris

Abstract

Snapping biceps femoris is a rare phenomenon in which the biceps femoris tendon subluxates over the fibular head when the leg is brought into deep flexion. Two primary pathologies have been identified: biceps insertion tears/anatomic variants and/or an enlarged fibular head. Often, it can be treated nonoperatively; however, if symptoms are severe enough and refractory to conservative treatments, the underlying pathology can be corrected surgically to alleviate symptoms. The diagnosis is made clinically; the subluxation should be reproducible with deep flexion and should abate with manual compression of the biceps muscle and internal rotation of the tibia. Radiographs can help to discern the size and shape of the fibular head, and magnetic resonance imaging can often help to determine any abnormal tendon insertions. The surgeon should be comfortable with the anatomy of the lateral knee. It is critical to protect the common peroneal nerve. With the appropriate correction, the subluxation can be eliminated and symptoms dramatically improved.

Traumatic biceps femoris tendon subluxation in a young football player

“…Our patient had a prominent fibular head and a history of trauma. Published surgical options include reinsertion of the anomalous arm of the long biceps femoris tendons through a tunnel into the fibular head or directly onto the periosteum with anchors, 1,3,19 partial osteotomy of the fibular head 4 or simple partial release of the anomalous tendon. 19 In our patient, the prominence of the fibular head and the previous trauma resulted in painful subluxation of the biceps tendon over the later aspect of the fibula.…”

“…These include relocation of the long head biceps femoris insertion or resection of the fibular head. 3,4 We report a case of symptomatic snapping knee due to a biceps femoris tendon trauma in a young soccer player with a 12-month follow-up.…”

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 ].…”

“…Saltzman et al described two cases of abnormal insertion onto proximal anterolateral tibia treated by reinsertion of anomalous tendon to fibular head with pie crust lengthening [ 12 ]. McNulty et al, Fung et al, Bach et al, and Hadeed et al showed cases with normal tendon anatomy and prominent fibular head, where treatment consisted of partial fibular head excision [ 15 , 16 , 17 , 18 ]. Crow et al and Vavalle and Capozzi described cases with normal biceps femoris attachment and fibular head anatomy.…”

Snapping of bilateral biceps femoris tendons: A case report and brief review

“…Etiologies are diverse and grouped under anomalous tendon insertion [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , subluxation of an anatomically normal tendon [ 12 , 13 ], abnormal fibular morphology [14] , [15] , [16] , [17] or trauma [ 2 , 18 ] with the anomalous insertion etiology being the most common. Symptoms may be mild but, in few cases, they have been reported to affect daily activities [1] .…”