Hôpital Pitié-Salpétrière, Université Paris-Sorbonne, Paris, France; Clinique Jouvenet, Paris, France; CMC Drouot, Paris, France.
Hôpital Pitié-Salpétrière, Université Paris-Sorbonne, Paris, France; CMC Drouot, Paris, France.
Orthop Traumatol Surg Res. 2022 May;108(3):103255. doi: 10.1016/j.otsr.2022.103255. Epub 2022 Feb 17.
Abnormal biceps femoris distal tendon insertion can cause tendon snapping, as is well-known in the literature. The presenting symptom is lateral knee pain, often during sports activities and cycling in particular. The present study tested two hypotheses: abnormal biceps femoris insertion on the fibular head may cause painful friction without clinical snapping, whether visible, audible or palpable; surgical correction achieves good results for pain and return to sport, regarding both snapping and friction.
Between 2006 and 2017, 11 patients were managed for pain secondary to abnormal biceps femoris insertion. In 4 cases, pain was bilateral, resulting in a total of 15 knees: 9 with snapping (in 6 patients), and 6 with friction syndrome without snapping (in 5 patients). All 6 patients with snapping were male, with a mean age of 29 years. Friction without snapping concerned 3 female and 2 male patients, with a mean age of 30 years. Study data included type and level of sport, clinical signs, imaging, type and results of treatment, and type of abnormality.
The insertion abnormality consisted in excessively anterior insertion in the fibular arm in 6 cases, in predominantly tibial insertion in 2 cases, and in isolated tibial insertion in 4 cases. Surgery mainly consisted inrelease and reinsertion of the distal biceps femoris tendon (in 7 cases). All patients were able to return to sport. The mechanism underlying snapping and friction was the same: distal biceps tendon friction on the fibular head secondary to unduly anterior fibular or predominantly or exclusively tibial insertion.
The literature reports 24 cases, all of snapping, with between 1 and 3 cases per author. These findings were compared with the present results. With or without snap, symptoms are secondary to abnormal tendon insertion and to activity or sport requiring repeated knee flexion greater than 90°.
(1) Case studies show that lateral knee pain by friction on the fibular head is not systematically accompanied by snapping. (2) In all reports and in the present series, surgery was highly effective on snapping and pain, and patients returned to sport at their previous level.
IV.
众所周知，肱二头肌股骨远端肌腱异常附着可导致肌腱弹响。主要表现为外侧膝关节疼痛，尤其是在运动和骑自行车时。本研究检验了两个假设：异常的肱二头肌股骨附着于腓骨头可能会引起疼痛性摩擦，而无临床弹响声，无论是否可见、可闻或可触及；手术矫正可有效缓解疼痛并重返运动，无论是弹响还是摩擦。
2006 年至 2017 年，我们对 11 例因肱二头肌股骨异常附着引起疼痛的患者进行了治疗。其中 4 例为双侧疼痛，共 15 个膝关节：6 例有弹响（6 例患者），6 例有摩擦综合征但无弹响（5 例患者）。6 例有弹响的患者均为男性，平均年龄 29 岁。5 例有摩擦但无弹响的患者为女性，2 例为男性，平均年龄 30 岁。研究数据包括运动类型和水平、临床体征、影像学表现、治疗类型和结果以及异常类型。
附着异常包括 6 例腓骨支附着过度靠前，2 例主要为胫骨附着，4 例为孤立性胫骨附着。手术主要包括肱二头肌股骨远端肌腱的松解和重新附着（7 例）。所有患者均能重返运动。弹响和摩擦的机制相同：由于腓骨或主要或仅胫骨附着异常，肱二头肌远端肌腱在腓骨头处摩擦。
文献报道了 24 例病例，均为弹响，每位作者报道 1-3 例。将这些发现与本研究结果进行了比较。有或无弹响，症状均继发于异常肌腱附着，以及需要反复膝关节屈曲大于 90°的活动或运动。
（1）病例研究表明，腓骨头处的摩擦性外侧膝关节疼痛并非总是伴有弹响。（2）在所有报告和本系列中，手术对弹响和疼痛均具有高度疗效，且患者能重返运动且达到之前的运动水平。
IV 级。
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