I've actually just watched this yesterday. This guy explains how cartilage regeneration works. Although you've had yours removed. I don't know how much it will help you, but here you go: https://youtu.be/6PNBjKJ9hxQ?si=qgOSsUB4Q7RNqPTI More on reddit.com

Cartilage injuries are tricky because the where and szie matter. Few buckets of options. Conservative Strengthen quads/hips + correct mechanics sometimes enough if maltracking/imbalances are the driver. Activity modification (bike, swim, ski fine; avoid high-impact). Injections: HA, PRP, stem cell variable evidence, mostly symptom relief not regrowth. They can be combined and how it's done makes a difference. Surgical / biologic Chondroplasty (shaving/smoothing) Usually not great for outcomes long-term, as you’ve heard. I wouldn't do it. I would be cautious if chondroplasty is presented as the primary solution for a significant focal cartilage defect. Microfracture Small defects, creates fibrocartilage can help if very very small size and not too active but I'd avoid it. you can burn bridges. Bad long term outcomes. I personally don't think it's worth doing, i'd just skip surgery at that point and do pt unless your goals is fewer options later and a few years of relief. You are active so this isn't an option for you. OATS // Mosaicplasty: Good for small focal lesions, especially in load-bearing zones. Watch out though I had this suggested by a doctor before for a 4.5 cm defect. I'd try to limit it to a cm, and even then I'm not a huge fan anymore unless an aci option has been ruled out. ACI eg MACI (autologous cultured chondrocyte implantation): Good for larger defects in younger/active patients; 1–2 stage surgery, long rehab, but best chance of hyaline-like repair. I will personally vogue for this. If you can handle the rehab it's incredible. By this i mainly mean follow the protocol. It takes time. I've had 4-5 cm defects fixed with it. One open one arthroscopic. The arthroscopic one let me just say I've had worst flus it's been really easy. granted the location matters if it's a load bearing area it's a little loger of immobility. My previous surgery 2 years ago was a lot harder too because I had meniscus repar, and then maci after. The goal being I'd get two shots at the repair one during the harvest and second during the implant. But it worked great on both accounts. Maci requires 2 procedures, but if your defect is under 4cm it's two very small procedures arthroscopic and that's the biggest factor. Anything open is harder. More swelling/rehab etc. On my second MACI I was walking in 2 weeks full weight. Running or anything like that is 6-months to a year. Allograft (OCA): Option for bigger/complex defects when your own cells/tissue not enough. I think this is still pretty reasonable for load bearing areas and other areas where MACI doesn't always do as well. alignment and mechanics If the damage is driven by alignment eg kneecap tracking, varus/valgus load) they may add an osteotomy or TTO (tibial tubercle osteotomy) to offload Without fixing mechanics cartilage work can fail. It usually drops success rate quite a lot. So they look at that on the evals. The pay off is there if you need it. choose algo: Small defect symptoms tolerable > physio + injections active with focal full-thickness defect -> OATS or maci/oca. Large degenerative / diffuse arthritis ->cartilage surgery usually doesn’t work; then it’s replacement territory. For cartilage surgery, the rule is usually fix anything wrong with the knee that's contributing to the issue (meniscus/ mechanics) do MACI whenever you can. then the other ones after that. MACI has a high success rate if you follow the rules, you need to know what you are getting into and you don't burn bridges. Doctors Always get a second opinion or a third. Find a doctor that specializes in cartilage. They should do all the main treatments, so they aren't biased against one or the other. make sure you understand everything take your time. It's worth traveling and going out of your way to find the right doctor. More on reddit.com

I had the same thing on my femur. I did all the PT, MACI, and I currently did my second OATS on 12/28. I’m 7 surgeries in at this point and Here is what you should know: PT is a part time fix. You can strengthen all the muscles you want but it will not fix or alleviate your symptoms. It’s nice to have a strong leg going to surgery but that’s all you will have. Something to think about is: PT is going to be your life post op. You can do all the PT you want after surgery. Save the PT visits for after surgery depending on your insurance. I’ve had 5 scopes and they are also temporary. They feel great! Cleaning everything up, shaving everything down will alleviate pain. But it will come back. PRP is not a guarantee either and not covered by insurance when it was offered to me. This is a 50/50 chance of helping. It’s straight out of pocket so if you have the cash and want to try it, go for it. This might be controversial but I would pick OATS over a MACI. If you are healthy and young, your chances for MACI are good. Remember they are using your cells to grow this thing. MACI didn’t fix my problem. You are getting a great, strong healthy donor bone for your OATS and you get to skip the first MACI surgery where they go in and harvest your cells. Then they have to grow them and then you get to schedule surgery. This could be a while and insurance loves to turn you down this. They also will turn you down for OATS regardless of what your doctor’s not says so make sure you have a doctor that will put in the work to get this approved. My doc called and told me it took 2 minutes to convince them to do the surgery. Anyway, back to the OATs, at least you are starting with a solid, strong plug already in place. Do your research. God, please do this. Don’t trust just anyone to do this surgery. It sounds easy but you need a good surgeon that you like because you are going to be with them for a while, this isn’t a short process. Same with PT, make your PT knows how to do MACI and OATS PT. It’s not just your run of the mill PT. Yes you do the same exercises but you need someone who knows what to do when. This is a long process. Be in a good place mentally. Make sure you have a caregiver that will take care of you. More on reddit.com

For those who want to know more : https://med.stanford.edu/news/all-news/2025/11/joint-cartilage-aging.html A very good news 😍 More on reddit.com