Partial Fibular Head Resection Technique for Snapping Biceps Femoris

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.