Extensive grade iv patellar chondromalacia particularly along median patellar ridge & medial patellar facet. there is evidence for patella alta. so, what does this mean, & do i need knee replacement?

Loss of cartilage: Chondromalacia means loss and/or damage to the cartilage that covers the bone. In your case, you have damage on the back and inside of the kneecap, and grade IV is the most severe grade of injury/loss. Patella alta means the kneecap is sitting higher (closer to the hip) than it normally should. We treat patients, not necessarily mris. How you are treated depends on your symptoms and disability.

No: You have patellofemoral disease. You might be able to avoid knee replacement surgery. If the weight-bearing surfaces are involved as well that is a different story. Isometric quadriceps strengthening exercises can help. A patellar stabilizing knee sleeve also might help. Avoid squatting crawling kneeling and repetitive stairs.

Orthopedist: Further orthopedic consultation will help guide your decision. Your kneecap (patella) is resting higher than normal (alta) and has calcified arthritic changes (chondromalacia). There are some non-surgical options including physical therapy, but your orthopedist will have to clarify what your best option is.