Normal patellofemoral kinematics. As the knee flexes and extends, the
patella tilts, rotates, and shifts with respect to the trochlea,
incorporating six degrees of freedom of patellar movement. Measurements
of patellar height vary at different degrees of knee flexion and can
confound evaluation of the patella alta. Standard lateral radiographs
used to define the normal range of patellar height are obtained at
30° of flexion. Standard CT and MR images are obtained with the
knee in extension; therefore, the patella is normally positioned more
proximally relative to the trochlea.