What do positive and negative patellar tilt test results indicate?

Patellar Tilt Test: Interpretation of Results

Test Result Documentation

A positive patellar tilt test indicates tight lateral retinacular structures and is documented when the examiner cannot elevate the lateral patellar edge to neutral (horizontal) or beyond. A negative test means the lateral edge can be elevated to or past neutral, suggesting normal lateral retinacular flexibility.

Clinical Interpretation

Positive Test Result

• Inability to elevate the lateral patellar edge to neutral or beyond indicates:
  • Tight lateral retinacular structures 1
  • Potential lateral patellar tracking abnormality 2
  • May suggest patellofemoral malalignment 1

Negative Test Result

• Ability to elevate the lateral edge to neutral or beyond indicates:
  • Normal lateral retinacular flexibility 1
  • No significant lateral soft tissue tightness 3

Important Clinical Caveats

Limited Diagnostic Utility

• The patellar tilt test has poor to fair reliability with intrarater reliability coefficients of 0.44-0.50 and interrater reliability of 0.20-0.35 3
• The test shows low sensitivity (<50%) but moderate to high specificity (72-100%) for patellofemoral pain syndrome 1
• A positive likelihood ratio of 5.4 suggests some diagnostic value, but falls short of the threshold (>10) for definitive diagnosis 2

Clinical Context Required

• The test should not be used in isolation, as physical examination findings are more useful than radiographic measures for patellofemoral pain syndrome 1
• Care must be taken in placing too much emphasis on this test when making clinical decisions given its reliability limitations 3
• Weight-bearing axial radiographs provide superior objective assessment of patellar tilt when imaging confirmation is needed 4, 5

Documentation Standards

Medical records should specify:

• Whether the lateral edge could be elevated to neutral or beyond (negative) 3
• Whether the lateral edge remained below neutral despite manual pressure (positive) 3
• The degree of resistance encountered during the maneuver 1