The reliability and validity of assessing medio-lateral patellar position: a systematic review

Medio-lateral patellar position is regarded as a sign of patellofemoral pain syndrome and patellar instability. Its assessment is important in accurately performing patellofemoral therapeutic taping techniques. The purpose of this paper is to systematically review the literature to determine the reliability and validity of evaluating medio-lateral patellar position. An electronic database search was performed accessing AMED, British Nursing Index, CINAHL, the Cochrane database, EMBASE, Ovid Medline, Physiotherapy Evidence Database (PEDro), PubMed and Zetoc to July 2008. Conference proceedings and grey literature were also scrutinised for future publications. All human subject, clinical trials, assessing the inter- or intra-tester reliability, or the criterion validity, were included. A CASP tool was employed to evaluate methodological quality. Nine papers including 237 patients (306 knees) were reviewed. The findings of this review suggest that the intra-tester reliability of assessing medio-lateral patellar position is good, but that inter-tester reliability is variable. The criterion validity of this test is at worse moderate. These are based on a limited evidence-base. Further study is recommended to compare the McConnell (1986) [McConnell J. The management of chondromalacia patellae: a long term solution. Australian Journal of Physiotherapy 1986;32(4):215-23] and Herrington (2002) [Herrington LC. The inter-tester reliability of a clinical measurement used to determine the medial/lateral orientation of the patella. Manual Therapy 2002;7(3):163-7] methods of assessing medio-lateral patellar position in patients with well-defined patellofemoral disorders.