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The rule of no thumb test was compared with the towel clip test in determining the need for lateral retinacular release in 200 consecutive primary total knee replacements. The towel clip test was positive in 13 knees (6.5%) and the rule of no thumb test was positive in 78 knees (39%). Using a positive towel clip test as the indication for lateral retinacular release, there was no radiographic evidence of patellar tilt, subluxation, or dislocation in any knee at 6 months postoperatively. Therefore, the rule of no thumb test falsely predicted the need for lateral release in 65 knees (32.5%). The authors advocate the towel clip test to determine the need for lateral retinacular release.

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