### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi Doctors, I have no acl intact in my left knee . I went through 2 surgeries on my left knee , I had a miniscal surgery several year a go. I also have a grade IV Chondromalacia in my right knee, i do not want do any more surgeries at the age of 54YEARS.

### output:

Hi, thank-you for providing the brief history of you. A thorough musculoskeletal assessment is advised. As the pathology of the knee joint is troubling you, and you also do not want to go for surgery I will advise to try physical therapy. As with physical therapy, your pain and inflammation will be reduced by use of therapeutic ultrasound therapy and TENS therapy. Also, since you have Grave IV Chen Chat Doctor.  If the ACL is completely torn then surgery will be advised as the life expectancy of the knee has to be kept into consideration. Also, once ACL reconstruction is done you can later proceed to physical therapy for strengthening exercises and ROM exercises which will help to extend the life of the knee joint. Due to ACL injury, the knee joint enters into faster degeneration, so ACL reconstruction will be advised in my opinion. As it is a small procedure and recovery is also optimum. Also, once ACL reconstruction is done, you may avoid the TKR in the future. To avoid TKR you need to understand that ACL reconstruction is important. Rest I leave a choice on you. In my clinical practice, I avoid surgery for my patient with grade I ACL injury but witChatDoctorplete tear I also advise surgery, post which the knee ROM and strengthening is performed, and optimum results are achieved with 100% of success. RegardsJay In