From the Research
The patellar tilt test is a valuable clinical examination used to assess patellar alignment and potential lateral retinaculum tightness in patients with anterior knee pain or suspected patellofemoral disorders, and its findings should be interpreted with caution due to moderate reliability and diagnostic accuracy, as reported in recent studies 1, 2.
Purpose and Interpretation of the Patellar Tilt Test
The patellar tilt test is performed with the patient lying supine and relaxed quadriceps, while the examiner attempts to lift the lateral edge of the patella from the lateral femoral condyle.
- A positive test is indicated when the lateral edge cannot be raised to at least neutral (horizontal) position, suggesting lateral retinaculum tightness.
- A normal test allows the lateral edge to be lifted to at least 0 degrees (horizontal) or even to a positive angle.
Clinical Importance and Limitations
This test is important because lateral patellar tilt can contribute to patellofemoral pain syndrome, patellar maltracking, and potentially patellar instability, as discussed in recent reviews 3, 2.
- The findings help clinicians determine if lateral retinacular release might be beneficial in treatment planning.
- However, the reliability and diagnostic accuracy of the patellar tilt test are moderate, with studies reporting fair to moderate inter-rater reliability and diagnostic accuracy 4, 1.
Comprehensive Assessment and Treatment Planning
The test should be interpreted alongside other clinical findings, including:
- Patellar glide test
- Q-angle measurement
- Imaging studies for a comprehensive assessment of patellofemoral mechanics. Proper technique requires gentle manipulation without forcing the patella, as excessive pressure can cause patient discomfort and muscle guarding that invalidates results, as emphasized in recent studies 5, 2.