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Patellar Tilt Test

 Patellar Tilt Test


The primary purpose of the Patellar Tilt Test is to evaluate tension in the lateral retinaculum of the patella.

See Also: Patellar Grind Test

How do you do Patellar Tilt Test?

The patient lies in supine position.

The examiner passively displaces the patella laterally, noting how it behaves during lateral displacement.

What does a positive Patellar Tilt Test mean?

Where the lateral retinaculum is very tight due to contracture, the lateral facet will dip toward the femur (negative patellar tilt test ‘abnormal’).

negative patellar tilt test
Negative test

Where there is normal tone in the retinaculum , the patella will remain at roughly the same height with respect to the femur (neutral tilt test).

neutral patellar tilt test
Neutral test

With laxity of the lateral retinaculum and with generalized ligament laxity, the lateral margin of the patella will rise up out of the trochlear groove (positive tilt test).

positive patellar tilt test
Positive test

Accuracy

In a study by C J Watson to evaluate the reliability of the lateral pull test and tilt test to assess patellar alignment in subjects with symptomatic knees, he found that the kappa coefficients for intrarater reliability varied from 0.39 to 0.47 for the lateral pull test and from 0.44 to 0.50 for the patellar tilt test.

While the coefficients for interrater reliability were 0.31 for the lateral pull test and varied from 0.20 to 0.35 for the tilt test.

Superoinferior Patellar tilt

Examiner visually estimates patellar alignment while palpating superior and inferior patellar poles.

Patellar orientation graded using an ordinal scale extending from −2 to +2:

  • with −2 representing inferior patellar pole below superior pole,
  • +2 representing inferior patellar pole above superior pole.

Anterior Patellar tilt

Examiner palpates inferior patellar pole.

If examiner easily palpates inferior pole, no anterior tilt exists. If downward pressure on superior pole is required to palpate inferior pole, it is considered to have an anterior patellar tilt.

Anteroposterior Patellar tilt component

Examiner palpates inferior and superior patellar poles.

Scored 0, 1, or 2:

  1. Score is 0 if inferior patellar pole is as easily palpable as superior pole.
  2. Score is 1 if inferior patellar pole is not as easily palpable as superior pole.
  3. Score is 2 if inferior pole is not clearly palpable compared with superior pole.

Inferior Pole Patellar Tilt

Examiner applies a posterior force with index finger on superior pole of patella and observes for tilting of inferior pole of patella.

Patellar mobility graded as diminished or nondiminished.

The sensitivity and specificity of Inferior Pole Patellar Tilt was 19% and 83% ,respectively.

Patellar Lateral Pull Test

With patient supine and knee extended, examiner asks patient to perform isometric quadriceps contraction. Examiner observes patellar tracking during contraction.

Patellar Lateral Pull Test is positive if patella tracks more laterally than superiorly.

It’s Negative if superior displacement is equal to lateral displacement.

Notes

Where the tilt test is neutral or positive, a lateral release to decom press the patellofemoral joint will hardly improve symptoms at all.

However, it may be expected to improve symptoms in cases where the tilt test is negative.

Patients with a positive tilt test greater than 5° and medial and lateral gliding of the patella exhibit poor results after an isolated lateral release.

Dysplasia of the trochlear groove can lead to atypical test results.

The tilt test should always be performed comparatively on both knees

Download

Download a pdf version of Patellar Tilt Test PDF

References

  1. Watson CJ, Leddy HM, Dynjan TD, Parham JL. Reliability of the lateral pull test and tilt test to assess patellar alignment in subjects with symptomatic knees: student raters. J Orthop Sports Phys Ther. 2001 Jul;31(7):368-74. doi: 10.2519/jospt.2001.31.7.368. PMID: 11451307.
  2. Tomsich DA, Nitz AJ, Threlkeld AJ, Shapiro R. Patellofemoral alignment: reliability. J Orthop Sports Phys Ther. 1996;23:200-208.
  3. Fitzgerald GK, McClure PW. Reliability of measurements obtained with four tests for patellofemoral alignment. Phys Ther. 1995;75:84-92
  4. Watson CJ, Propps M, Galt W, et al. Reliability of McConnell’s classification of patellar orientation in symptomatic and asymptomatic subjects. J Orthop Sports Phys Ther. 1999;29:378-393.
  5. Sweitzer BA, Cook C, Steadman JR, et al. The interrater reliability and diagnostic accuracy of patellar mobility tests in patients with anterior knee pain. Phys Sportsmed. 2010;38(3):90-96.
  6. Clinical Tests for the Musculoskeletal System 3rd Edition.
  7. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

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