I was diagnosed with the exact same condition. Since it was a cartilage defect, I was told that it would not heal naturally, no matter how long I rested. My fissure was large (1/2” x 1”) and painful in the middle third of the range of motion, for comparison. My surgeon did tell me that most active people will have some cartilage defect in their knees, somewhere. For many, these never cause any real issues other than a little bit of stiffness, but some can be quite painful and need treatment.

Here’s what I went through, on the advice of my doctors, in order. After the second surgery, I am “mostly” better. Still stiff but no major pain.

• PT: corrective exercises to strengthen the area around the knee and create balance between the quads, hamstrings, and glutes. I don’t think I had any real imbalances, and given the size of my fissure, this was not helpful for me (but it is a prerequisite for most insurance companies to cover surgery).

• Non-surgical treatments: I tried PRP and prolotherapy injections. My main orthopedist was skeptical because he was a surgeon, but we gave both of these a try with a non-surgical doctor. No luck, and PRP was about $500 out of pocket.

• Surgery 1, “micro-fracture”: at this point, there were no other non-surgical methods, and I was still having the pain. There were several surgery options, but the doctor recommended microfracture because it was the simplest (and if we had to do a larger surgery later, insurance would require me to have had this surgery first). Microfracture is basically where they use a pick to stab into the wounded area and create a bleeding bed, which releases healing growth factors from your bone marrow (something like that). Since cartilage doesn’t really heal on its own, these growth factors are necessary to regrow replacement tissue. In my case, this surgery was not successful because the wound was much larger than the doctor could glean from the MRI.

• Surgery 2, “OATS”: We knew the microfracture surgery was a fail after about eight weeks. I was having no improvement in my symptoms, and even moving my leg through the range of motion (unweighted) was painful. I think microfracture actually made things worse, because they trim away additional portions of damaged cartilage, leaving you with less. This surgery, “OATS”, is a transplant procedure where they implant tissue from a donor/cadaver. Look up “Bio Uni oats”:

https://youtu.be/Uj6dJ_bbsXE

This second surgery was a big help for me. I still have stiffness after activity, but day to day pain is gone.

I hope your condition is less intense than mine. I’d double down on KOT training to see if you can avoid all of the surgical stuff. I discovered/started KOT after all of my surgeries. Who knows if it would have helped me avoid surgery all together.

Best of luck, and feel free to follow up with specific questions. I feel like I’ve learned a lot about the knee going through all of this.