Q. A 13-year-old boy is brought to the physician’s office by his mother for pain around his right knee for the past 1 month. In the beginning, it started as mild pain, but gradually it has become severe. The pain is present throughout the day and it increases during activities and at night. He denies any fever, rash, or weight loss. His temperature is 98.6°F (37°C), pulse is 92 beats per minute, BP is 110/70 mm of Hg and respiratory rate is 15/min. Physical examination shows a non-erythematous swollen right knee joint and is tender with decreased range of motion. Deep tendon reflexes are normal with muscle strength of 5/5. The rest of the examination is normal. Laboratory evaluation is shown below. Plain X-ray shows both radiodense and radiolucent areas in the distal femur with cortical destruction and new bone formation in the periosteal region. The nearby soft tissue regions show variable radiodense regions in a radial pattern. What is the best next step in management?