Thanks for posting your query.
In chondromalacia, there is softening or wearing down of the articular cartilage
on the back of the patella
(kneecap) or other bone surface in the joint. Grade 4 is the worst stage .
Treatment for grade 4 Chondromalacia depends on your symptoms. If you have severe pain
and are limited in daily activities or can't play sports like you want to, then you have to consult an orthopedic surgeon about surgery.
Surgery can include microfracture procedure if it's limited to a small area or cleaning up the joint and smoothing the surfaces via scope.
You can also treat it conservatively including physical therapy
, RICE, taking a break from activity, strengthening, etc.
Wishing you good health
Dr Saurabh Gupta