Repair of Distal Biceps Femoris Avulsion and Lateral Collateral Ligament Reconstruction: Surgical Pearls

Isolated avulsions of the distal biceps femoris are infrequent; however, they often occur in combination with other injuries to the posterolateral corner of the knee including the lateral collateral ligament (LCL). We describe a technique for LCL reconstruction with semitendinosus allograft through a bone tunnel in the fibula, followed by transosseous biceps femoris repair utilizing the cannulated biotenodesis screw from the LCL reconstruction. The LCL is reconstructed via bone tunnels and biotenodesis screws at both the femoral origin and fibular insertion utilizing the allograft. Two FiberTape sutures (Arthrex, Naples, FL) are passed in a Krackow fashion through the biceps femoris tendon, yielding two proximal and two distal limbs. The distal limbs are passed through the cannulated tenodesis screw in the fibula, bringing the biceps femoris tendon over the lateral fibula. These limbs are then brought back through the biceps femoris tendon and tied to the proximal limbs, completing the biceps femoris repair. The excess allograft can be sutured to the biceps femoris for reinforcement.