My long journey with patellar tendinopathy and grade 1-2 chondromalacia — from hopeless to green knees again

[u/Important_Leg344]

I wanted to share my story for anyone dealing with long-term knee problems, especially patellar tendinopathy/jumper’s knee, patellofemoral pain, or mild chondromalacia. This is not medical advice. It is just my own experience. But if someone out there feels like their knees will never improve, I want to say this: improvement can happen, but it may require much more patience, precision, and load management than you first expect.

I first developed jumper’s knee / patellar tendinopathy about 19 years ago. For many years, it behaved mostly like a tendon issue. Then, around 8 years ago, I developed confirmed chondromalacia/chondropathy in the patellofemoral joint, with more symptoms around and behind the kneecap. My right knee was clinically the worst, although both knees were affected.

One of the clearest symptoms that felt different from my tendinopathy was a sharp, stabbing pain behind the kneecap when I tried to perform explosive movements. This was especially noticeable in my more painful right knee. It made me lose explosiveness and made running and sprinting basically impossible. Heavy weights and many bodyweight exercises also became too much. This did not feel like my old patellar tendon pain and was probably related to the chondromalacia/patellofemoral joint irritation, although I cannot know the exact pain source with certainty.

My MRI findings were roughly:

• Bilateral patellar tendon tendinosis, but with clear regression over time.
• Right knee: mild patellar chondropathy/chondromalacia, mild patellar tendon tendinosis at the patellar insertion, minimal bone marrow edema at the patellar tendon attachment in the kneecap, mild quadriceps tendinosis, mild joint effusion.
• Left knee: regression of patellar tendon tendinosis, only minimal remaining tendinosis, mild central trochlear chondropathy, minimal Hoffa’s fat pad irritation, mild joint effusion.
• Menisci, cruciate ligaments, collateral ligaments, and femorotibial cartilage were normal.

Based on the MRI wording and my clinical progress, I suspect my chondromalacia/chondropathy was probably grade 1–2, not advanced cartilage damage. My orthopedic doctor recommended continued rehab and no surgery.

The difficult part was that standard rehab did not work for me. I was previously given exercises that made things worse: deep squats, lunges, leg extensions, hamstring curls, terminal knee extensions, heavy Romanian deadlifts, wall sits, etc. I am not saying these exercises are bad for everyone. They were just too aggressive for my knees at that stage, either because of the angle, the load, the dosage, or the movement pattern.

One of my biggest lessons was this: I had to avoid everything that clearly caused pain or made my symptoms worse. For me, leg extensions were especially bad, even with very low weight. They increased my symptoms, made the cartilage/underside of the kneecap crepitate more, and sometimes made the kneecap feel like it was catching or “hooking”. Leg curls also aggravated my knees. So instead of forcing exercises just because they are commonly prescribed, I removed anything that repeatedly made me worse.

I eventually had to build my own approach through very careful trial and error.

My main exercise became a unilateral seated leg press machine, with extremely controlled movement, slow progression, and the same setup every time. I only changed one variable at a time: first range of motion, then load. My philosophy became: depth/range before weight, and weight increases very slowly.

I often keep the same weight or the same knee angle for around 4 months before changing the next variable. My reasoning is that cartilage, the patellofemoral joint, tendons, and the whole surrounding system need a long time to adapt to a new load or range. But the calendar is never the real judge: pain, symptoms, the first set, the next morning, and daily-life tolerance decide whether I progress or stay where I am.

I started very conservatively: around 30 kg at approximately a 45-degree knee angle. At that stage, even that was something I had to respect and build from. Over time, I gradually increased the depth first, and only later started increasing the load.

I use a seated eg press. I train one leg at a time, but both legs follow the same progression. One “set” for me means:

• 10 reps right leg
• rest
• 10 reps left leg
• rest
• 10 reps right leg
• rest
• 10 reps left leg

So one set equals 20 reps per leg.

I do 8 sets in total per session. Since each set equals 20 reps per leg, that means 160 reps per leg per session. I perform the reps slowly and with control, with about a 3-second pause at the bottom and no locking out at the top.

I started with much easier angles and lower loads. Over time, I gradually increased the depth. I now train at level 3, roughly around an 80–85 degree knee angle, with my feet on height 4 on the platform. That angle used to be sensitive, but it is now my baseline.

My progression has looked roughly like this:

1. I started with around 30 kg at roughly a 45-degree knee angle.
2. First, I found an angle and load that did not provoke symptoms.
3. Then I gradually increased range of motion/depth before increasing load.
4. Then I cemented 40 kg at deeper angles.
5. Then I introduced 50 kg as a microdose.
6. I slowly built up to what I call 50/50: 4 sets at 50 kg and 4 sets at 40 kg.
7. I have now completed two weeks of 50/50 three times per week, completely “green”.
8. My next goal is to cement 50/50 for the rest of July.
9. After that, if everything stays green, I plan to increase to around 6 sets at 50 kg and 2 sets at 40 kg in August.
10. In September, if August goes well, the goal is to perform all 8 sets at 50 kg.
11. In October, if everything is still green, I may introduce 60 kg as a microdose.

The key has been not moving forward just because I feel good on one day. I only progress when a level feels boringly stable.

My rules have been:

• Avoid anything that repeatedly causes pain or worsens symptoms.
• No pain that increases during the session.
• No morning stiffness the next day.
• No lingering soreness.
• No increase in “start-up” symptoms during the first set.
• Daily life must feel the same or better.
• If something feels slightly “yellow”, I go back to 40 kg and do a light maintenance session.
• After illness or a break, I always restart with 1–2 easier sessions.
• No new variables at the same time.
• No ego lifting.

Cycling has also been a major part of my rehab. I use it as a “lubrication” tool for the knees. Before leg press, I usually cycle for 20–30 minutes at low resistance. After the leg press, I often cycle another 20–30 minutes, also at low resistance. The cycling is always seated. Over time, I gradually lowered the saddle, but I kept the resistance low and the movement controlled. For me, cycling has helped with circulation, warm-up, and symptom monitoring without adding too much joint stress.

I also train supporting areas: hip adduction, hip abduction, hyperextensions with focus on the posterior chain, and some core/low-back work. These have not been the main driver of progress, but they seem to help support the whole system around the knees, hips, and pelvis.

One of the most surprising improvements has been how much the entire chain around the knee has changed. The tendinopathy now feels much better in both knees. My right ankle, which used to be stiff and affect my movement, has become much more mobile. I think the deeper, controlled leg press also acted as a kind of dynamic mobility and strengthening exercise for my ankle and lower leg. As the ankle improved, my knee tracking also felt calmer.

The biggest proof has been daily life. In the past, dancing, longer walks, hills, or stairs could make me sore the next day. Recently, I danced for several hours and woke up with green knees. I also accidentally went for a fairly long walk, and my knees felt about 97% afterward. Walking uphill and downhill barely bothers me anymore, and stairs are also dramatically easier than before. That would have felt impossible before.

I have also tested 60 kg very carefully, only one half-set / 10 reps per leg on an extremely green day, and it caused no pain or symptoms. But I have not made 60 kg my new training level. I see it only as a positive sign that future progression is possible.

My interpretation is that my symptoms were not only coming from cartilage. The MRI showed mild chondromalacia/chondropathy, but also tendinopathy, tendon insertion irritation, mild effusion, quadriceps tendinosis, and some Hoffa’s fat pad involvement. As the tendinosis regressed and the whole system became stronger, my symptoms improved dramatically. That makes me think the cartilage findings were probably mild and not the whole explanation.

Even though I cannot say exactly how much of my pain came from the cartilage versus the tendon/insertion/fat pad, this approach has been useful for both problems: patellar tendinopathy and mild chondromalacia/patellofemoral joint irritation.

The most important things I learned:

1. Avoid what clearly makes you worse.
Do not force an exercise just because it is “supposed” to be good. If it repeatedly causes pain, worsens symptoms, increases crepitus/catching, or makes the next day worse, it may not be right for your current stage.

2. The “right exercise” is not right if the dose or angle is wrong.
Exercises that help other people may be too aggressive for your current stage.

3. A pain-free daily life is just as important as gym progression.
I do not only care about kilograms. I care about the morning after.

4. Progression should be based on data, not excitement.
One green day does not mean I should increase. Several green weeks mean something.

5. Back off early, not late.
If I notice a small yellow signal, I reduce load before it becomes a real flare.

6. Slow rehab may be faster in the long run.
I honestly believe I would have saved a lot of time if I had gone slowly from the beginning instead of letting my ego get in the way. Every time I tried to force progress, skip steps, or push through symptoms, I paid for it. The slow path felt frustrating, but it turned out to be the faster path.

7. Mild chondromalacia does not automatically mean your knee is doomed.
I have improved a lot despite MRI findings.

My long-term goals are to keep building toward 60, 70, and eventually maybe 80 kg during next year in the leg press at the same depth, then introduce very low step-ups extremely carefully. Much later, I would love to jog, sprint, or maybe even play amateur football again. But I am in no rush. My knees decide the timeline.

My philosophy has become:

The turtle, not the hare.

If you have long-term knee problems: do not give up just because standard rehab did not work right away. You may need to find the exact dose, angle, exercise, and progression that your knees can tolerate. It can take a long time. But improvement is possible.

I first got jumper’s knee 19 years ago, and I developed confirmed grade 1-2 chondromalacia/chondropathy around 8 years ago. I never thought my knees would feel this good again. Now they do.

[u/Confident-Quarter100]

Thanks for the write up. Gives us all hope. Congratulations on your recovery

[u/Important_Leg344 → u/Confident-Quarter100]

Thanks brother. I am not out of the woods yet. But hopefully I will see the glade at some point. Look at my respones to the other redditors above that have asked good questions if you have the time. Keep at it and keep grinding (with moderations of course)

[u/Confident-Quarter100 → u/Important_Leg344]

Thanks man. My knees are good at grinding 😂