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A 15-year-old female cross country runner presents with 5 weeks of right knee pain. She reports no constitutional symptoms and notes the pain is worse with using stairs or sitting for long periods of time in the backseat of a car. Physical examination shows that her range of motion is full and there is no effusion. There is approximately one quadrant of passive medial or lateral patellar glide. She has pain with resisted open chain knee extension. There is more hip external rotation than internal rotation bilaterally and hip range of motion is painless. Radiographs of the right knee are found in Figures A-C. What is the next most appropriate step in management?
Obtain AP, frog leg lateral, Dunn view, and false profile hip radiographs
CT scan to obtain tibial tubercle-trochlear groove measurements
Physical therapy regimen focused on quadriceps and core muscle strengthening program
Physical therapy regimen focused on Graston, ASTYM, and iontophoresis techniques
Obtain chest CT, skeletal survey, and refer to an orthopaedic oncologist
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HPI - 38 yr old very active with anterior knee pain for many years. Was told it was nothing by many orthopods.
Clear valgus alignment
Imaging shows patella alta with increased TTTG distance. Lateral patella facet and lateral trochlea chondral damage.
Decided to proceed with arthroscopy after initial trial of non op treatment.
What should be the next step of treatment?