From the history you have presented, it sounds like you mean chondromalacia in your knee cap joint (patella). It is difficult to comment on whether you require surgery or not as multiple factors will need to be assessed such as whether you have trialled conservative care (exercise rehab, medications), what sort of biomechanics you present with and other pathology in your knee apart from the kneecap joint.
If I can assume that your general biomechanics are not so bad and that you do present with osteoarthritis in your knee, then all the research points to losing weight if you are overweight to lessen the load on the knee. If you are not overweight, then an intense rehabilitation program is needed specific to your knee/leg focused at regaining the correct muscle activation patterns to help keep your knee cap stable and tracking the right way. Other considerations with your rehab program should involve looking at your hip, pelvis, lower leg, feet and surrounding muscles at these regions to make sure they are all working in alignment and turning on at the right time respectively. Only then will the load in the knee be dispersed lessening the pain in the region. Be prepared for weeks to months of exercise rehabilitation.
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