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An 18-year-old female has 9 months of anterior knee pain recalcitrant to physical therapy that includes VMO strengthening, NSAIDS, and lifestyle modification. On physical examination she has no effusion in the knee and her Q angle is measured at 15 degrees. She has less than one quadrant of medial patella translation and less than two quadrants of lateral patella translation. The lateral edge of the patella is unable to be everted. A merchant view radiograph is shown in Figure A. The tibia tubercle-trochlear groove distance is measured as 14mm on a CT scan. Which of the following procedures is MOST appropriate?
Lateral retinacular release
Anterolateral tibial tubercle osteotomy
Anterior tibial tubercle osteotomy (Maquet)
Medial tibial tubercle osteotomy (Elmslie-Trillat)
Medial plica resection
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A 21-year-old female presents with left knee pain for six months. The symptoms are worse climbing stairs and sitting for long periods of time. On physical exam she has a stable knee with no effusion and pain with compression of the patella. Her Q angle is 21 degrees. What is the first step in management?
arthroscopic lateral retinacular release
tubercle elevation and medialization
strict immobilization and non-weight bearing for four weeks
open chain exercises and a focus on seated leg extensions
closed chain exercises with focus on quadriceps and hamstring strengthening