Review Question - QID 218696

An 11-year-old boy complains of dull, aching pain over the anterior aspect of his right knee. His mother states that he does not complain when walking, but his football coaches have stated that this knee has been bothering him during practices for about a month. The patient’s mother also states that he has grown about 2 inches in the past 2 months. The patient is mildly tender to palpation over the anterior aspect of the tibial tubercle but is most painful on active extension of the knee against resistance. The remainder of his exam is nonpainful. There is no effusion, he ambulates without a limp, and his knee is stable to varus/valgus stress and to Lachmann and posterior drawer testing. He has one quadrant of patellar translation with a firm endpoint and has no angular deformities on clinical examination. Which of the following radiographs is most associated with this condition?