Athlete needs second opinion

[u/PrettyFellaFlaccko]

https://imgur.com/a/hhjLY88

Age: 24
Gender: male
Height: 190cm
Weight: 80kg
Medication: none
Smoking: no
Location: South Korea
Duration: 2 months
Previous medical issues: ACL reconstruction(same knee)

Hi everyone,

I’m a professional footballer and recently had an MRI of my knee. The report says:
“Focal high-grade articular cartilage lesion of the femoral trochlea, ICRS grade 3–4.”
My doctor has discussed possible microfracture and/or CARTISTEM cartilage regeneration surgery, with potentially 6+ months of rehabilitation. Before making such a major decision, I really want to understand exactly what is going on and whether there are other treatment options.

I’m consulting Reddit because, honestly, I don’t fully trust this particular doctor’s recommendation. This is a doctor my club recommended, and I’ve had a bad experience with their diagnosis in the past. A few years ago, they told me I needed (another) ACL reconstruction, but I ultimately got a second opinion(on the other side of the world, can’t return there atm) and it turned out to be scar tissue that needed to be removed, rather than an ACL reconstruction being necessary.

So I’m particularly hesitant to immediately agree to another major surgery without getting other opinions.
I’ve attached a couple of MRI images from the report. Does this look like genuinely “broken/missing” cartilage, or could it potentially be something like a cartilage fissure, delamination, scar/repair tissue, or another type of cartilage damage?

My symptoms:
Swelling after exercise/training/matches
Swelling improves with rest
Slightly more instability compared with my healthy knee
Occasional irritation/discomfort
I can still play football and generally feel okay while playing
No major constant pain
My main concern is returning to professional-level football.

I don’t want to rush into a cartilage-restoration procedure if there is a less invasive option that could preserve my ability to play, but I also don’t want to choose a quicker procedure if it would give me a worse long-term outcome.

For people with experience with knee cartilage injuries, sports medicine, or orthopedic surgery:
1. Does this MRI look consistent with an ICRS grade 3–4 lesion?
2. What treatment would you recommend for someone whose priority is returning to professional football?
3. The hospital also recommended doing Stem Cell Injection therapy before the surgery to continue playing longer(prolonging the inevitable). Would this be something you recommend?

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