Treatment for Patellar Tilt and Subluxation

Diagnostic Evaluation

• Initial assessment should include weight-bearing axial radiographs to evaluate patellofemoral kinematics and demonstrate the degree of patellar tilt or subluxation, as recommended by the American College of Radiology 1, 2
• CT is the most commonly used modality for measuring axial malrotation when more detailed assessment is needed, especially when evaluating component rotation in post-total knee arthroplasty patients, according to the American College of Radiology 1, 3
• MRI with metal artifact reduction techniques may be used to detect patellar complications when radiographs are inconclusive, as suggested by the American College of Radiology 1

Conservative Management

Bracing and Support

• Orthotic devices may be beneficial, particularly for patients with foot pronation or pes planus that contributes to malalignment, as noted by the American Academy of Family Physicians 4

Special Considerations

• For patients with total knee arthroplasty, patellofemoral instability (1-12% incidence) is often due to internal malrotation of the femoral and/or tibial components, as reported by the American College of Radiology 1