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A 22-Year-Old Man Comes to the Office Due to Intermittent

question 460

Multiple Choice

A 22-year-old man comes to the office due to intermittent right knee pain that has been increasing for the past 8 weeks. The pain began after the patient participated in a recreational soccer tournament, but he does not recall any significant injuries. He has intermittent, moderate pain associated with a sensation of "catching" in the knee while walking. At times he is unable to completely extend the knee. The patient also had swelling at the joint several days after the pain began, but the swelling slowly resolved. The symptoms affect his daily routine, especially outdoor activities, which he has not done since the injury. He has taken over-the-counter acetaminophen with inconsistent relief. On examination, his gait is grossly normal. There is full, pain-free range of motion of the knee with no erythema, warmth, or swelling. No ligamentous laxity is found with varus or valgus stress, or with anterior or posterior traction on the lower leg. With the knee held in internal and external rotation, flexion and extension at the knee elicits moderate pain and crepitus. X-ray of the knee is normal. Which of the following is the best next step in management of this patient?

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