Royal London Hospital Test Knee | Patellar Tendinopathy Exam

Patellar Tendinopathy is one entity of anterior knee pain syndromes and is a frequently encountered clinical picture in those who do jumping sports such as volleyball, basketball, or track, and field running. Cook et al (2001) evaluated the validity of tendon palpation in the diagnosis of the condition and reported a sensitivity of 68% and low specificity of 9% when comparing to visible tendinopathic lesions on Ultrasound.

Maffulli et al. (2017) who previously had proposed the Royal London Hospital Test for Achilles tendinopathy now examined a similar test to diagnose patellar tendinopathy and compared it to manual palpation as well. They found a sensitivity of 88 and a specificity of 98% for the royal London hospital test in their small sample of 30 patients.

In their study, manual palpation also yielded markedly higher sensitivity and specificity compared to Jill Cook’s study though the definition of a positive finding on ultrasound was different, and the setting for patient recruitment differed as well, so despite the high numbers, the clinical value remains moderate.

To conduct the test, the patient lies in supine and the patella tendon is palpated for local tenderness from proximal to distal while the knee is extended. Once local tenderness is elicited, the tender portion of the tendon is again palpated but now with the knee bent to 90°, which places the tendon under tension.

The test is considered positive if the pain is markedly reduced or absent in knee flexion. The reason why symptoms decrease with the tendon under tension is unknown.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Common orthopedic tests to assess for patellar tendinopathy are:

• Patellar Tendon Palpation

References

Cook, J. L., Khan, K. M., Kiss, Z. S., Purdam, C. R., & Griffiths, L. (2001). Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. British journal of sports medicine, 35(1), 65-69.

Maffulli, N., Oliva, F., Loppini, M., Aicale, R., Spiezia, F., & King, J. B. (2017). The Royal London Hospital Test for the clinical diagnosis of patellar tendinopathy. Muscles, Ligaments and Tendons Journal, 7(2), 315.