Patellar tilt test

Written by Dr Sheila Strover on March 14, 2025

The patellar tilt test assesses the tautness of the retinacular tissue on either side of the patella. A tight retinaculum on one side may cause excessive pressure against the wall of the underlying groove, leading to pain.

Position of the fingers for the patellar tilt test.

Illustration demonstrating the patellar tilt test.

How to perform the patellar tilt test

The patellar tilt 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.

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What does a positive patellar tilt test imply?

If the patient is suffering from pain in the front of the knee (anterior knee pain), then a positive patellar tilt test implies that the pain may be caused by excessive pressure on the undersurface of the patella on the one side, caused by tight tissues on the one side (tight lateral retinaculum).

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

Daniel Sisk et al

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

RP Grelsamer et al

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Can surgery relieve patellar tilt?

Surgery can help relieve the tilt but the surgeon needs to be sure that it is the patellar tilt that is causing the patient's symptoms, as there are various causes of pain in the front of the knee.

The 'diagnosis' of 'Anterior knee pain' may have been given to the patient, but it is a rather vague term to mean 'pain experienced in the front of the knee', and tends to be used interchangeably withthe equally vague term of 'Patellofemoral Pain Syndrome' as the discomfort most often originates with problems relating to the patella and its underlying groove, but only careful assessment will give the true cause of the pain, as the fat pad and ligamentum mucosum have also been identified as sources of pain in the front of the knee.

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.

Li Minghao et al

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A-Z Keywords

Lateral retinaculum, Anterior knee pain, Excessive lateral pressure syndrome, Lateral retinacular lengthening, Lateral release, Patellofemoral pain syndrome, Fat pad syndrome

Contributions by experts -

Dr Ronald Grelsamer - Patellofemoral pain

Forum discussions

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