If you’re in the US, I would start w/ something your insurance would actually cover. Synvisc/GelSyn/other brand injections will thicken the synovial fluid/increase viscosity, which may give you some lasting relief. Usually 3 injections, 1 per week for 3 weeks, twice a year. A lot of orthos will use these as a stop-gap measure until it’s time for a knee replacement. You can also research collagen supplementation. Pretty good evidence for it helping thicken articular cartilage, esp if taken 1 hour before exercising the joint. PRP may help w/ inflammation, but it’s not going to stimulate new cartilage growth. Intra-articular (into the joint) stem cell injections are insanely expensive ($3-5K), and haven’t really been shown to consistently improve cartilage growth. On the other hand, there are several fairly new procedures, like MACI, that use your own stem cells to grow a “patch” to put on the chondral defect. LONG rehab process, and too new for me to comment. I had a procedure where the doc drilled a hole into my femur and then injected stem cells into the bone/sub-chondral space. That has worked pretty well so far. You can also research “unloader braces”. I put a lot of patients in the Ossur brand w/ decent pain relief (this would be for every day wear, off the bike)
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