Patellar Tilt Test

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 Patellar Tilt Test


What is 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.

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

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. Clinical Tests for the Musculoskeletal System 3rd Edition.
  3. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.



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