Patellar tilt

Tight retinaculum on the lateral side. The medial retinaculum is not shown in this illustration.

What causes patellar tilt?

Patellar tilt may be the result of a number of factors, including tight thigh muscles and flat feet.

It is associated with a tight lateral retinaculum - the tissue at the outer side of the knee - but that tightness may be a result and not a cause of the tilt.

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Patellar tilt and instability

Patellar tilt may be static or associated with instability such as patellar subluxation or even dislocation.

• Quote from peer-reviewed paper:

  "....in the evaluation of [patellar instability], it will be beneficial to pay particular attention to [trochlear dysplasia], patella alta, and increases in both the TT-TG and lateral patellar tilt, although other factors are also considered...."

  Citation: Ormeci T, Turkten I, Sakul BU. Radiological evaluation of patellofemoral instability and possible causes of assessment errors. World J Methodol. 2022 Mar 20;12(2):64-82. doi: 10.5662/wjm.v12.i2.64. PMID: 35433342; PMCID: PMC8984217.

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Cartilage damage from patellar tilt

Chronic patellar tilt may eventually cause excessive lateral pressure syndrome (ELPS) which may lead to damage of articular cartilage, with changes in both the medial cartilage from pressure alteration and overload on the lateral cartilage which may lead to arthritic damage there and chronic pain.

• Quote from peer-reviewed paper:

  "....A lateral tilt, when the medial border is higher than the lateral border, can lead to lateral patellofemoral compression syndrome...An inferiorly tilted patella can be problematic as it may pinch or irritate the patellar fat pad that lay underneath the patellar tendon...."

  Citation: Loudon JK. BIOMECHANICS AND PATHOMECHANICS OF THE PATELLOFEMORAL JOINT. Int J Sports Phys Ther. 2016 Dec;11(6):820-830. PMID: 27904787; PMCID: PMC5095937.

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Forum discussions

• Patella tilt

  Patients considering the sequence of problems with patellar tilt.

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