The patellar tilt test is best for ruling in or ruling out PFPS?

• A. Ruling out
• B. Ruling in
• C. Neither
• D. Both

Answer: (B)

The patellar tilt test probes lateral retinacular tightness that can contribute to patellofemoral pain. When you attempt to tilt the patella medially and the patella cannot tilt or tilts only minimally because the lateral structures are tight, this finding supports maltracking from the lateral side, which is a common feature in PFPS. A positive tilt test therefore increases the likelihood of PFPS, helping to rule in the diagnosis. However, PFPS is multifactorial, so a negative tilt test doesn’t exclude PFPS, since other factors (like hip or quadriceps weakness, trochlear morphology, or tibiofemoral alignment) can produce similar symptoms.