Surgical management of tendinopathy of biceps femoris tendon in athletes.

PURPOSE: To report on the clinical features and results of surgical management of 11 athletes who were operated on for tendinopathy of the tendon of the biceps femoris.

METHODS: Eleven male athletes (average age 24.4, range 18 - 27 years) underwent surgery for tendinopathy of biceps femoris tendon. At surgery, if the tendon appeared grossly intact, with only minimal signs of adherences to the surrounding tissues, an extensive tenolysis and multiple longitudinal tenotomies were performed. If areas of tendinopathy were identified, they were excised and sent for histology. The tendon of the biceps femoris was sutured along the longitudinal tenotomy with Vicryl. If the tendon of biceps femoris was torn, the proximal end of the tendon received a Krackow stitch with Vicryl, and two suture anchors were inserted in the fibular head. The tendon of the biceps femoris was thus reconstructed. Functional ability was scored with the Cincinnati Knee Rating System.

RESULTS: The Cincinnati rating system showed a statistically significant improvement from a preoperative average rating of 35 (range 23 to 54) to an average of 74 (range 62 to 80) postoperatively (p < 0.05).

CONCLUSIONS: Surgery should be considered when well-supervised nonoperative management of biceps femoris tendinopathy fails. Stripping of the paratenon, removal of degenerated tissue, and multiple longitudinal tenotomies of the biceps femoris tendon should be performed. If the tendon is torn, it should be repair under appropriate tension, and, if necessary, reinserted on the head of the fibula.