The distal biceps femoris tendon inserts on the fibular head, splitting around the LCL like a sleeve. This insertion reinforces the posterolateral corner alongside the LCL and popliteofibular ligament. Distal biceps femoris avulsion from the fibular head (the arcuate sign on plain radiograph) indicates posterolateral corner injury. In PLC reconstruction, the biceps femoris tenodesis technique augments the LCL-popliteofibular reconstruction.
Knee flexion, external tibial rotation, and dynamic posterolateral knee stabilisation through the fibular head insertion
Distal biceps femoris tendinopathy produces posterolateral knee pain reproduced by resisted knee flexion and external rotation. The fibular attachment is palpable posterolaterally at the knee. Complete avulsion produces posterolateral instability and requires PLC reconstruction.
Fibular head avulsion producing posterolateral instability managed with PLC reconstruction incorporating biceps tenodesis.
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