Royal London Hospital Test (Patellar)

Context

The Royal London Hospital Test may aid in the diagnosis of patellar tendinopathy.

Patellar tendinopathy (PT), also known as “jumper’s knee,” is commonly seen in sports involving running and jumping (Figueroa et al., 2016). It is an overuse injury resulting from the repeated extension of the knee (van Ark et al., 2016).

The key to an accurate clinical diagnosis lies in a well-localized (focal) complaint at the attachment of the patellar tendon to the patella. On clinical examination, symptoms are typically exacerbated during high-energy-storage activities involving the knee extensors, such as jumping, changes of direction, sprinting, etc. In their 2017 study, Maffuli et al. sought to determine whether the Royal London Hospital Test was reproducible, sensitive, and specific for the diagnosis of patellar tendinopathy.

Video of the Test

Execution

To perform this test, the patient lies on their back with their knees straight, and the therapist palpates the tendon to check for local tenderness. The therapist then palpates the sensitive area of the tendon again with the knee flexed to 90°. The test is considered positive if the pain is significantly reduced or absent when the knee is flexed. The reason why tensioning the tendon causes a reduction in symptoms is unknown.

Clinical Value

Maffuli et al. (2017) report that in symptomatic patients with PT, the Royal London Hospital Test showed lower sensitivity (88% vs. 98%) and higher specificity (98% vs. 94%) than manual palpation (Aicale et al., 2020).

In this study, the Manual Palpation Test had a much higher clinical value than that found by Cook et al. in their 2001 study. This could be explained in part by the difference in the definition of ultrasound-detected tendinopathy between the two studies.

Maffuli et al. recommend that clinicians perform both tests for a correct clinical diagnosis of PT tendinopathy. They emphasize that a positive Palpation Test alone may not necessarily be associated with patellar tendinopathy, whereas positivity in both clinical tests is strongly associated with the presence of patellar tendinopathy on ultrasound.

In everyday practice, it is important to keep in mind that imaging is not considered necessary for a clinical diagnosis of tendinopathy (Scott et al., 2020).