Multiple problems in one knee

So, my knee saga is a tad complicated, as I've been diagnosed with many issues in the same knee, and at this point I'm completely at my wits end. Three years ago, I was experiencing quite a bit of pain and sought help from my doctor. After x-rays and PT and finally an MRI, I was diagnosed with osteochondritis dissecans of my patella. The MRI also showed a considerable amount of arthritis on the medial side, as well as inflammation of my patellar tendon right where it connects to the tibial tuberosity. I've done three years of PT now, and have been through the gauntlet of different inflammation/ pain meds, cortisone injections, viscosupplentation, kinesiology taping and several different styles of braces. The only thing which has given me any relief is the Euflexxa injections, though the relief was not evident until 9 weeks after the final injection and the effects lasted only 6 months. Now, after another MRI there is patellar tracking disorder, chondromalacia, subluxing patella, much more arthritis throughout and some floating cartilage in the inner joint area. I am diabetic, and both my doc and myself are not for the idea of a TJR as I do not heal very well. Oral meds do nothing to dull or stop the pain. The brace does assist somewhat with one problem- keeping my patella in place- but it agitates my other problems. At several points my knee is extremely painful to the touch. Ice is used daily, as well as elevation. I still do my strengthening PT exercises and as much walking as possible, because I know for a fact that letting her get stiff can lead to worse problems. Basically, when I walk my knee feels like she is going to fall apart. When I am at rest, my knee feels like an elastic which is being stretched too tightly. I am unable to straighten my leg- I assume because of the loose bodies. I do not get much sleep as a result from the pain, and I feel that surgery is necessary, but at the same time the docs seem unsure as to whether to do an MPFL or a tibial tuberosity transfer. I'm assuming that they'll perform debridement and remove the loose bodies. I'm not sure if anyone else can relate, but insight would be greatly appreciated. 😕

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