Final answer:
For a 46-year-old male with anterior knee swelling interfering with kneeling, initial management should include a clinical evaluation and potentially conservative treatments. If these are inadequate, arthroscopic surgery may be considered to address any intra-articular injuries.
Step-by-step explanation:
The most appropriate management for a 46-year-old male with a 2-month history of right anterior knee swelling, the size of a golf ball, that interferes with his ability to kneel, should start with a thorough clinical evaluation. This evaluation would likely include a physical examination, patient history, and potentially imaging studies like an MRI to determine the underlying cause of the swelling. The management could range from conservative treatments such as rest, ice, compression, and elevation (RICE), to medications like non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling. If these measures are inadequate and the condition is interrupting the patient's daily activities and job requirements significantly, more invasive options like arthroscopic surgery may be considered. This minimally invasive surgery could help in the diagnosis and treatment of potential intra-articular damage, such as meniscal tears or ligamentous injuries, which could be contributing to the swelling. The decision to pursue surgery would be made based on the specific findings related to the patient's knee condition and overall health status.