The “Snapping” Biceps Femoris Tendon: Systematic Review and Report on Two Cases

Abstract

background: The “snapping” biceps femoris tendon is an unusual cause of lateral knee pain. Two cases, documented here, stimulated a systematic review in order to determine whether it was possible to synthesise a set of common presenting signs for this condition, and to determine the optimal intervention for this presentation. Methods: Detailed descriptions of the cases are provided. The systematic review comprised of searching MEDLINE, EMBASE, CINAHL, AMED and SportsDiscus, and citation tracking. results: The review only generated published case reports or case series (Fourteen operated knees in total). No other forms of study on this condition exist in the literature. Synthesis of these cases revealed the following most commonly occurring signs in the presentation of this disorder: male gender; “snapping” of biceps femoris tendon over head of fibula between 75 and 120 degrees leading to lateral knee pain; atraumatic onset; failure of conservative treatment; aggravated by sport, stair climbing and squatting; normal imaging; and tenderness on palpation of tendon insertion. conclusion: This study is the first to synthesise all currently published cases in an attempt to facilitate recognition of this disorder. There are commonly occurring signs that the clinician should be able to easily recognise. In all cases where there was a documented attempt at conservative management the subjects failed to improve with this intervention, and all responded well to surgery being pain free and asymptomatic at follow-up (Two weeks to three years) and returning to previous levels of sporting activity where documented.