Insall-Salvati ratio

Last revised by Dr Yuranga Weerakkody on 15 Apr 2022

The Insall-Salvati ratio or index is the ratio of the patella tendon length to the length of the patella and is used to determine patellar height

The Insall-Salvati ratio is probably the most commonly used measurement to assess patellar height. It is affected by the presence of tibial tuberosity abnormalities (e.g. Osgood-Schlatter disease, osteotomies) and a different technique may be required when these are present 4,5

The Insall-Salvati ratio was initially determined on a 30° flexed lateral knee x-ray and was later applied to sagittal MRI. 

Distance lines are used to calculate Insall-Salvati ratio:

  • A: patellar tendon length (TL): length of the posterior surface of the tendon from the lower pole of the patella to its insertion on the tibia 
  • B: patellar length (PL): greatest pole-to-pole length

Insall-Salvati ratio = A/B (or TL/PL)

On plain radiographs:

On MRI, different thresholds are used due to intermodality differences in measurement technique (e.g. indirect vs direct visualization of the patellar tendon). The following is usually accepted as reasonable 1:

  • patella baja: <0.74
  • normal: 0.74-1.5
  • patella alta: >1.5

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Cases and figures

  • Figure 1: I-S index: red line/yellow line
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  • Figure 2: normal patella
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  • Figure 3
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  • Figure 4: MRI Insall-Salvati index
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