Patellar Apprehension Test

The Patellar Apprehension Test is an orthopedic examination designed to assess for patellar instability—particularly a tendency for the kneecap (patella) to dislocate laterally (toward the outside of the knee). It’s most useful for clients with a history of patellar dislocation, subluxation, or apprehension during knee activity.

How the Test is Performed

• Client position: Supine (lying on back), knees relaxed and flexed to ~30°.

• The examiner applies gentle lateral pressure to the medial border of the patella (moves patella outward) while supporting the leg.

• A positive test: The client experiences apprehension (anxiety, fear, or muscle guarding), and may physically resist the examiner’s hand or attempt to straighten the knee to “protect” the patella when it nears the point of potential dislocation.

  • Note: The sensation of possible dislocation or instability—not pain—defines a positive test.

• No “hard” endpoint—the result is based on the client’s reaction, not just movement.

Clinical Significance

• A positive Patellar Apprehension Test suggests patellar instability or prior dislocation and highlights risk for future dislocations or subluxations.

• Common in young, active individuals, athletes, or those with shallow trochlear grooves or previous traumatic knee injuries.

• The test is highly sensitive and specific for instability, but clinical judgment, functional assessment, and imaging are recommended to confirm diagnosis.

Assessment

• Use this test for clients with history of knee instability, patellar dislocation, subluxation, or ongoing fear/anxiety during activity.

• Document both the physical findings and the client’s reaction (level of apprehension/guarding, side affected) for communication and referral.

Treatment

• If positive:

  • Avoid direct, deep manual therapy over the patella or aggressive mobilization/lateral pressure on the kneecap.

  • Focus on gentle soft tissue techniques for quadriceps, IT band, and peri-patellar stabilizers—building confidence in safe movement.

  • Integrate strengthening, neuromuscular retraining, and proprioceptive work for the quadriceps, hip abductors, and gluteals to improve patellar tracking.

  • Educate about activity modification, strengthening, taping/bracing (if needed), and avoiding positions/movements that cause apprehension until stabilization is ensured.

Safety and Referral

• Refer for orthopedic/physio evaluation if repeated instability, strong apprehension, or new dislocations are reported—medical imaging and stabilization programs may be needed.

• Use the test to monitor surgical or rehabilitation outcomes in clients post-patellar stabilization surgery.