Radiographic Analysis of Patellar Tilt 822 the Journal of Bone and Joint Surgery

We describe the radiographic measurement of the angle of tilt of the patella and relate it to malalignment of the extensor mechanism. The tilt angle is defined as the angle subtended by a line joining the medial and lateral edges of the patella and the horizontal. The radiograph (Merchant type) is taken with the foot pointing up, the lower edge of the film parallel to the ground, and the knee at 30#{176} fiexion. The mean tilt angle of a group of patients with signs and symptoms suggesting patellofemoralmalalignment was 12#{176} (± 6#{176}); in a similar group of control subjects it was 2#{176} (± 2#{176}) (p < 0.01). Tilting of 5#{176} was taken to be the limit of normal. For the detection of patellar malalignment, the tilt angle was almost as specific as the congruence angle (92% v 99%) but more sensitive (85% v 25%) and more accurate (89% v 62%).