Tagliero Adam J, Tadepalli Vaibhav R, Werner Brian C
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Video J Sports Med. 2024 Aug 6;4(4):26350254241239978. doi: 10.1177/26350254241239978. eCollection 2024 Jul-Aug.
Snapping biceps femoris syndrome (SFS) represents a rare clinical entity in which the biceps femoris subluxates over the fibular head in deep flexion. Two primary pathophysiologies have been described including a prominent or abnormal fibular head morphology. Others have implicated an anomalous biceps femoris insertion. The diagnosis is made clinically, with operative and nonoperative intervention strategies available for treatment.
SFS often results in audible snapping and associated pain at the lateral fibular head. When recalcitrant to nonoperative management, surgical intervention can lead to resolution of symptoms. We present the case of a college-aged male who has bilateral symptoms, worse on the right, which have resulted in significant activity modification and daily discomfort recalcitrant to anti-inflammatory medication and physical therapy.
The patient was placed supine on the operating room table with an ipsilateral bump under the hip to assist in exposure of the lateral aspect of the knee. Examination under anesthesia (EUA) confirmed the snapping biceps femoris. A lateral approach to the knee and a common peroneal neurolysis was performed. The biceps femoris insertional anatomy was examined for anomalous tendon insertion or insertional tearing. The prominent fibular head was exposed and resected, with careful attention not to disrupt the lateral collateral ligament or popliteofibular ligament insertion sites. The biceps femoris was then repaired to the prepared bony bed of the fibula with one double-loaded suture anchor. Repeat EUA confirmed complete resolution of snapping even with maximal internal rotation of the tibia; this was carefully examined again with the tourniquet deflated to ensure its compressive effect was not partially responsible for the resolution.
Published data pertaining to SFS is limited to case reports and small case series. With appropriate indications, surgical intervention yields promising results with a high percentage of patients returning to prior level of activity or prior participation level in sport.
DISCUSSION/CONCLUSION: SFS can be diagnosed with a careful clinical assessment. When recalcitrant to nonoperative management, it is effectively treated with surgical intervention to restore normal fibular anatomy, and prevent recurrent instability and persistent pain. The presented technique allows for appropriate management of these rare injuries.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
股二头肌弹响综合征（SFS）是一种罕见的临床病症，在深度屈膝时股二头肌会在腓骨头处发生半脱位。已描述了两种主要的病理生理学机制，包括突出或异常的腓骨头形态。其他人则认为是股二头肌附着异常。该诊断通过临床做出，有手术和非手术干预策略可供治疗。
SFS常导致腓骨头外侧出现可闻及的弹响及相关疼痛。当对非手术治疗无效时，手术干预可使症状得到缓解。我们报告一例大学年龄男性，双侧出现症状，右侧更严重，导致其显著改变活动方式且日常不适，抗炎药物和物理治疗均无效。
患者仰卧于手术台上，患侧臀部下方垫一沙袋以协助暴露膝关节外侧。麻醉下检查（EUA）证实存在股二头肌弹响。采用膝关节外侧入路并进行腓总神经松解。检查股二头肌附着处解剖结构，查看有无异常肌腱附着或附着处撕裂。暴露并切除突出的腓骨头，注意不要破坏外侧副韧带或腘腓韧带附着点。然后用一枚双股缝线锚钉将股二头肌修复至准备好的腓骨骨床。重复EUA证实即使在胫骨最大内旋时弹响也完全消失；松开止血带后再次仔细检查，以确保其压迫作用并非导致弹响消失的部分原因。
关于SFS的已发表数据仅限于病例报告和小病例系列。在有适当适应症的情况下，手术干预产生了令人满意的结果，很大比例的患者恢复到了先前的活动水平或运动参与水平。
讨论/结论：通过仔细的临床评估可诊断SFS。当对非手术治疗无效时，通过手术干预有效恢复正常腓骨解剖结构，可治疗SFS，预防反复不稳定和持续疼痛。所介绍的技术可对这些罕见损伤进行适当处理。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别，作者在提交本出版物时已包含患者的豁免声明或其他书面批准形式。
