Bilateral snapping biceps femoris tendon: a case report and review of the literature
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UP-TO DATE REVIEW AND CASE REPORT • KNEE - ANATOMY
Bilateral snapping biceps femoris tendon: a case report and review of the literature leuan Reid1 · Ali Mofidi1 Received: 11 December 2018 / Accepted: 31 January 2019 © Springer-Verlag France SAS, part of Springer Nature 2019
Abstract Snapping biceps femoris tendon is an uncommon cause of lateral knee pain. We report the case of a 15-year-old athlete with bilateral snapping biceps femoris tendons, painful over his right lateral leg during exercise. He underwent elective exploration of the right knee which revealed an accessory biceps femoris tendon with attachment to the anterolateral tibia. The accessory tendon was released and reinserted onto the fibular head with a Krackow suture. There were no perioperative complications, and he returned to full sporting activities within 3 months. We describe the operative technique used and summarise the existing literature. Restoring the anatomy with release of the accessory tendon and reinsertion onto the fibular head is an effective technique in the management of knee pain due to snapping biceps femoris tendon. Other approaches include simple release of the anomalous tendon without reinsertion or partial resection of the fibular head. Partial resection of the fibular head is the only technique described in the literature with complication requiring a further operation on the same site. There remains a paucity of evidence in the literature regarding long-term outcomes required to inform the best operative approach. Further anatomical, intraoperative and radiological studies are required to delineate the true pathology of this condition. Keywords Snapping biceps femoris · Operative technique · Case report · Anatomy
Introduction Snapping biceps femoris tendon is an uncommon cause of lateral knee pain. It is characterised by a painful click on flexion or extension of the knee, usually due to snapping of the distal tendon of the long head of the biceps femoris over the fibular head [1, 2]. The biceps femoris muscle complex can be described as having a long head and a short head with a distal conjoined tendinous insertion, separated into medial and lateral components by the fibular collateral ligament. These tendons form anterior and posterior (direct) extensions that insert into the anterolateral portion of the tibia and the fibular head, respectively [3, 4]. The snapping biceps femoris phenomenon may occur due to anomalous Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00590-019-02392-9) contains supplementary material, which is available to authorized users. * Ali Mofidi [email protected] 1
Abertawe Bro Morgannwg University Health Board, Swansea, Wales, UK
tendon insertion [5–13], subluxation of an anatomically normal tendon [14, 15], abnormal fibular morphology [1, 16–19] or secondary to trauma [2, 20]. Symptoms can affect activities of daily living and conservative management tends to fail, indicating a role for surgical intervention [1]. We report the case
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