So simply stated, if there is not a mechanical issue like a flip-flopping torn piece of the meniscus or a loose fragment of bone floating inside of the joint, there is only one other thing that can be causing the
knee pain, chondromalacia, or cavities in the protective enamel, resulting nerve irritation and pain. From a strict orthopedic perspective, there are two treatment options, arthroscopy, and total joint replacement.
If the X-Ray appears to be “bone on bone” and the patient’s clinical exam does not exhibit a mechanical cause of the pain, the cause must be chondromalacia. Since these 'potholes' are the source of the pain, there is no role for an arthroscope, as it is a cutting and grinding instrument.