Bilateral snapping biceps femoris tendon: a case report and review of the literature

  • leuan Reid
  • Ali MofidiEmail author
Up-to date Review and Case Report • KNEE - ANATOMY


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.


Snapping biceps femoris Operative technique Case report Anatomy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

ESM 1 Video demonstrating snapping of long head of patient’s right biceps femoris tendon on knee flexion (MP4 36170 kb)


  1. 1.
    Fritch BA, Mhaskar V (2017) Anomalous biceps femoris tendon insertion leading to a snapping knee in a young male. Knee Surg Relat Res 29(2):144–149. CrossRefGoogle Scholar
  2. 2.
    Bansal R, Taylor C, Pimpalnerkar AL (2005) Snapping knee: an unusual biceps femoris tendon injury. Knee 12(6):458–460. CrossRefPubMedGoogle Scholar
  3. 3.
    Terry GC, LaPrade RF (1996) The biceps femoris muscle complex at the knee. Its anatomy and injury patterns associated with acute anterolateral-anteromedial rotatory instability. Am J Sports Med 24:2–8. CrossRefPubMedGoogle Scholar
  4. 4.
    Tubbs RS, Caycedo FJ, Oakes WJ, Salter EG (2006) Descriptive anatomy of the insertion of the biceps femoris muscle. Clin Anat 19(6):517–521. CrossRefPubMedGoogle Scholar
  5. 5.
    Lokiec F, Velkes S, Schindler A, Pritsch M (1992) The snapping biceps femoris syndrome. Clin Orthop Relat Res 283:205–206Google Scholar
  6. 6.
    Hernandez JA, Rius M, Noonan KJ (1996) Snapping knee from an anomalous biceps femoris tendon insertion: a case report. Iowa Orthop J 16:161–163PubMedPubMedCentralGoogle Scholar
  7. 7.
    Kristensen G, Nielsen K, Blyme PJ (1989) Snapping knee from biceps femoris tendon. A case report. Acta Orthop Scand 60(5):621CrossRefPubMedGoogle Scholar
  8. 8.
    Date H, Hayakawa K, Nakagawa K, Yamada H (2012) Snapping knee due to the biceps femoris tendon treated with repositioning of the anomalous tibial insertion. Knee Surg Sports Traumatol Arthrosc 20(8):1581–1583. CrossRefPubMedGoogle Scholar
  9. 9.
    Matar HE, Farrar NG (2018) Snapping biceps femoris: clinical demonstration and operative technique. Ann R Coll Surg Engl 100(3):e59–e61. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bagchi KK, Grelsamer RP (2003) Partial fibular head resection for bilateral snapping biceps femoris tendon. Orthopedics 26(11):1147–1149PubMedGoogle Scholar
  11. 11.
    Ernat JJ, Galvin JW (2018) Snapping biceps femoris tendon. Am J Orthop. CrossRefPubMedGoogle Scholar
  12. 12.
    Bernhardson AS, LaPrade RF (2010) Snapping biceps femoris tendon treated with an anatomic repair. Knee Surg Sports Traumatol Arthrosc 18(8):1110–1112. CrossRefPubMedGoogle Scholar
  13. 13.
    Kissenberth MJ, Wilckens JH (2000) The snapping biceps femoris tendon. Am J Knee Surg 13(1):25–28PubMedGoogle Scholar
  14. 14.
    Crow SA, Quach T, McAllister DR (2009) Partial tendon release for treatment of a symptomatic snapping biceps femoris tendon: a case report. Sports Health 1(5):435–437. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Vavalle G, Capozzi M (2010) Symptomatic snapping knee from biceps femoris tendon subluxation: an unusual case of lateral pain in a marathon runner. J Orthop Traumatol 11(4):263–266. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    McNulty M, Carreau J, Hendrickson N, Bollier M (2008) Case report: snapping biceps femoris tendon due to abnormal fibular morphology. The Iowa Orthopaedic Journal 2017(37):81–84Google Scholar
  17. 17.
    Fung DA, Frey S, Markbreiter L (2008) Bilateral symptomatic snapping femoris tendon due to fibular exostosis. J Knee Surg 21(1):55–57CrossRefPubMedGoogle Scholar
  18. 18.
    Bach BR Jr, Minihane K (2001) Subluxing biceps femoris tendon: an unusual case of lateral knee pain in a soccer athlete. A case report. Am J Sports Med 29(1):93–95. CrossRefPubMedGoogle Scholar
  19. 19.
    Hadeed MM, Post M, Werner BC (2018) Partial fibular head resection technique for snapping biceps femoris. Arthrosc Tech 7(8):e859–e862. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Saltzman BM, Collins MJ, Arns TA, Forsythe B (2018) Unilateral snapping biceps femoris tendon with an anomalous insertion treated with anatomic repositioning and lengthening with a single suture anchor: a report of two cases. J Bone Joint Surg Case Connect 8(1):e13. CrossRefGoogle Scholar
  21. 21.
    Krackow KA, Thomas SC, Jones LC (1986) A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg Am 68(5):764–766CrossRefPubMedGoogle Scholar
  22. 22.
    Marchand AJ, Proisy M, Ropars M, Cohen M, Duvauferrier R, Guillin R (2012) Snapping knee: imaging findings with an emphasis on dynamic sonography. AJR Am J Roentgenol 199:142–150. CrossRefPubMedGoogle Scholar
  23. 23.
    Guillin R, Mendoza-Ruiz JJ, Moser T, Ropars M, Duvauferrier R, Cardinal E (2010) Snapping biceps femoris tendon: a dynamic real-time sonographic evaluation. J Clin Ultrasound 38(8):435–437. CrossRefPubMedGoogle Scholar
  24. 24.
    Kennedy MI, DePhillipo NN, Chahla J, Armstrong C, Ziegler CG, Buckley PS, Bernhardson AS, LaPrade RF (2018) Surgical repair of dynamic snapping biceps femoris tendon. Arthrosc Tech 7(11):e1129–e1133. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Abertawe Bro Morgannwg University Health BoardSwanseaUK

Personalised recommendations