Patellar tilt test

Position of the fingers for the patellar tilt test.

How to perform the patellar tilt test

The test is performed in the following manner -

• the patient lies on his/her back with the knee stretched out on the examination couch. The toes should be pointing straight up but the muscles must be relaxed with the joint at about twenty degrees of flexion (bent to 20 degrees).
• normally the patella lies parallel to the horizontal or the outer edge may be tilted up a little (less than 10 degrees).
• standing at the end of the examination couch, an examiner tries to lift up the outside edge of the patella (kneecap) using his/her thumb. The patella should not be pushed to the inside or the outside. Usually the outer (lateral) edge of the patella can thereby be tilted up about 20 degrees above the horizontal.
• if the lateral retinaculum is tight, the examiner may not be able to lift it up at all and the tilt test offers zero degrees of tilt. In such a situation the resting tilt may be zero or negative.

• Quote from peer-reviewed paper:

  "Tilting of 5 degrees was taken to be the limit of normal."

  Citation: Grelsamer RP, Bazos AN, Proctor CS. Radiographic analysis of patellar tilt. J Bone Joint Surg Br. 1993 Sep;75(5):822-4. doi: 10.1302/0301-620X.75B5.8376449. PMID: 8376449.

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What does a positive patellar tilt test imply?

• Quote from peer-reviewed paper:

  Arthroscopic "[l]ateral retinacular release is the main surgical treatment for ELPS....[but this surgery is often complicated by] hemarthrosis and medial patellar instability"....leading to new techniques that preserve the integrity of the joint capsule and limit the extent of the release.

  Citation: Minghao L, Zhenxing S, Qiang L, Guoqing C. Lateral Retinacular Release for Treatment of Excessive Lateral Pressure Syndrome: The Capsule-Uncut Immaculate (CUI) Technique. Arthrosc Tech. 2023 Oct 16;12(11):e1991-e1996. doi: 10.1016/j.eats.2023.07.018. PMID: 38094964; PMCID: PMC10714330.

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What is anterior knee pain?

'Anterior knee pain' is a rather vague term to mean 'pain experienced in the front of the knee.

There are various causes. The term tends to be used interchangeably with 'Patellofemoral Pain Syndrome' as the discomfort most often originates with problems relating to the patella and its underlying groove.

The fat pad and ligamentum mucosum have also been identified as sources of pain in the front of the knee.

• Quote from peer-reviewed paper:

  "....a laterally tilted patella can lead to high lateral forces on the lateral facet...."

  Citation: Sisk D, Fredericson M. Update of Risk Factors, Diagnosis, and Management of Patellofemoral Pain. Curr Rev Musculoskelet Med. 2019 Dec;12(4):534-541. doi: 10.1007/s12178-019-09593-z. PMID: 31773479; PMCID: PMC6942114.

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Forum discussions

• Re: Back again with new knee pain

  Patients discuss tight lateral retinaculum and anxiety about being offered lateral release surgery.

• Correcting Patella Tilt Non-Surgically

  A group of patients discuss physiotherapy and exercises to help correct patellar tilt.

• Info on Open Lateral Lenghthenig of the Retinaculum

  A group of patients tease out the issues of lateral retinacular lengthening and compare it with lateral retinacular release.

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