From the Guidelines
A positive patellar tilt test indicates lateral patellar tilt, which is a common finding in patellofemoral disorders, suggesting tightness of the lateral retinaculum and potential for patellofemoral pain syndrome, chondromalacia patella, and patellar tracking disorders. During this clinical examination, the examiner attempts to lift the lateral edge of the patella while the knee is extended and the quadriceps is relaxed. If the lateral edge cannot be raised to at least neutral position (parallel to the examining table), the test is considered positive. This finding is supported by radiographic assessments, such as axial radiographs, which demonstrate the degree of patellar tilt or subluxation 1. The use of weight-bearing axial radiographs is recommended to better assess patellofemoral kinematics, as suggested by Baldini et al, cited in the study on acr appropriateness criteria for imaging after total knee arthroplasty 1. Key points to consider in the interpretation of a positive patellar tilt test include:
- Lateral patellar tilt as a contributing factor to patellofemoral pain syndrome, chondromalacia patella, and patellar tracking disorders
- The role of tight lateral structures in creating abnormal pressure distribution across the patellofemoral joint
- The importance of radiographic assessment, including axial radiographs, in evaluating patellar complications and guiding treatment
- Treatment options, including physical therapy focusing on quadriceps strengthening and stretching of tight lateral structures, and in some cases, lateral retinacular release surgery if conservative measures fail.
From the Research
Patellar Tilt Test
- The patellar tilt test is used to assess lateral retinaculum tightness or insufficiency, along with the patellar glide test 2.
- A positive patellar tilt test indicates excessive lateral retinaculum tightness, which may lead to lateral patellar compression syndrome, lateral patellar instability, and arthritis 2.
- The test is also used to evaluate patellar alignment in subjects with symptomatic knees, although its reliability has been shown to be fair for intrarater and poor for interrater reliability 3.
- Lateral retinaculum lengthening or release may be performed to address excessive lateral retinaculum tightness, while repair or reconstruction may be indicated for lateral retinaculum insufficiency 2.
Clinical Implications
- The patellar tilt test is a valuable tool in the diagnosis and treatment of patellar instability and maltracking 4, 5.
- However, its results should be interpreted with caution due to the potential for variability in measurement and the need for careful clinical decision-making 3.
- The test may be used in conjunction with other diagnostic tools, such as imaging studies, to evaluate the patellofemoral joint and guide treatment decisions 2, 6.