A 9-year-old previously healthy male presented to the emergency department with anterior knee pain after kicking a ball at school. Patient was ambulatory at the school and in the ED although limping due to pain. Patient is an avid soccer player and has not had any previous knee injuries or issues related to knee pain. Physical exam showed a normal appearing knee with point tenderness at the inferior pole of the patella and proximal patellar tendon, painful but intact knee extension and painful ambulation with some mild limping. Distal neurovascular exam intact.