Left and right medial meniscus issues seeking the best treatment options.

[Jayguruson]

I am a 50 year old USMC Veteran with a service connected disability. I had recent x-rays and MRIs of both knees. I had a menisectomy of the posterior horn of my right medial meniscus in 1994 by a good surgeon friend. My knees are both in rough shape. I am also at the whim of the VA healthcare system, which has gotten a lot better but I feel it is still way behind the medical times....

Radiology reports state:

Right Knee - There is patchy grade 2/3 chondral thinning of the medial compartment articular cartilage. Grade 2 chondral thinning of the patellofemoral cartilage. The lateral compartment cartilage is intact. Mild marginal spurring of the medial compartment.  Small focus of multidirectional tearing of the body of the medial meniscus including a small radial component of tear.

Left Knee - There is patchy grade 2/3 chondral thinning of the medial compartment articular cartilage. Patchy grade 2/3 chondral thinning of the patellofemoral cartilage. Lateral compartment cartilage is intact. Impression:
1. Multidirectional tearing of the body and posterior horn of the medial meniscus.
2. Patchy grade 2/3 chondral thinning of the medial and patellofemoral compartment articular cartilage.

I had one corticosteroid shot in both knees which was useless and does not fix the problem but merely may reduce pain and swelling for a minimal period of time. It does not address a solution to the injured areas.

What is the best thing to do next, PRP or Synvisc shots? Perhaps consider meniscus transplantation or another option? I would appreciate the best advice that anyone would care to offer as my pain levels are growing quickly in both knees. I would rather not disguise the problem but deal with it head on as intelligently and self lovingly as possible. I love being active and do not want lousy knee replacements. I want to keep as much as I have for as long as I can. Thank you for your time, thoughtfulness and expertise.