An 18 year old woman comes to the physician because of knee pain that has been present for 5 years. The pain is made worse by prolonged sitting and by going up and down steps. She has 10 degrees of hypertension of both elbows. She becomes apprehensive when laterally directed pressure is applied to the patella. X-ray films show no abnormalities. Select the most appropriate next step in management?
A. Anterior cruciate ligament reconstruction
B. Arthroscopic partial meniscectomy
C. Quadriceps strengthening exercise
D. Symphathetic blockade
E. total knee replacement
F. Upper tibial osteotomy