Surgical treatment of distal hamstring ruptures at the knee is rare and has been reported infrequently in the literature. This article describes a 22-year-old former collegiate football player who had his career cut short secondary to a chronic distal rupture of the biceps femoris at the knee. Reconstruction of the distal biceps femoris tendon with semitendinosus allograft resulted in an excellent clinical outcome and allowed the patient to return to a high level of physical activity. This case presents a unique cause of knee pain and weakness in a young, active patient and a corresponding effective surgical treatment for such an injury.