(A) Coordinate systems used to quantify the clinical motions of the patella. The femoral system consisted of the transepicondylar axis (TEA) and the long axis intersecting at the center of the knee (mid-point of TEA). A box was fit around the patella to determine the patellar center. The patellar system consisted of the SI, AP, and ML axes. Patellar flexion, lateral shift, lateral tilt, and lateral rotation are considered positive as shown. (B) Articulation of the patella on the femur with flexion. The distal portion of the patella is in contact with the femur at low angles and the proximal portion is in contact with the femoral condyles at high flexion angles.