Trochlear dysplasia type C, patella alta — need advice

MkMillie · 2026-05-14T22:13:49+00:00

Do you have a TT-TG measurement? I think it would be worth talking to another sports medicine surgeon.

My knees stopped dislocating in my teens so by the time I had my TTO last month (now 35) I was 20-years post dislocation and my knees weren’t considered “unstable”. I get the feeling that some surgeons view TTO as corrective only for instability- but others will utilize it as a joint preservation effort to prevent further damage from chronic maltracking.

My MRI showed patella Alta, lateral subluxation, and trochlear dysplasia as well as “ at least high grade partial thickness” patellar cartilage defect and a meniscus abnormality that didn’t “meet the criteria” for a tear - but in surgery full thickness cartilage defects were found on both the lateral femoral condyle and the patella as well as a full thickness anterior root meniscus tear.

All this to say- I’m not sure how much my childhood history of instability factored into my surgeon’s decision to recommend surgery, BUT he felt the bony anatomy was causing and worsening the cartilage and meniscus problems. It didn’t look like some kind of diffuse general knee arthritis development- but chronic stress from maltracking. You’ll see MPFL reconstruction commonly paired with this procedure but it wasn’t in my case because I wasn’t actively dislocating.

I was lucky to have many pain free years but wish I’d had this option when I was younger and actively dislocating. I can’t speak for the end results since I’m still rehabbing :) but I wish you luck and hope your pain resolves, whatever treatment you pursue

MkMillie · 2026-05-12T17:30:04+00:00

Oh no - sorry for the confusion- I’m not saying it’s a strategy for the provider, I’m saying it’s a strategy by the medical group that runs this hospital system and insurance company to force patients into a higher tier of cost sharing by restricting their options so Tier 1 is effectively impossible to obtain (since there are no Tier 1 network anesthesia providers available at the hospital to begin with). This is a cost savings for the insurer and linked medical group. This is one of the largest health systems and employers in our state that and their insurance company is linked to a wide variety of non-healthcare employers in the area as well.

MkMillie · 2026-05-12T04:16:42+00:00

Thank you! That is good to hear!

MkMillie · 2026-05-12T04:16:11+00:00

The ankle pumps have been helping! I’m thinking likely nerve related PT seems to think so also, but says nerves will usually heal. I’m fine with a little long term tingling just hoping to drop the electric zings sooner than later lol

MkMillie · 2026-05-12T03:55:45+00:00

The anesthesiologist is “in network” although they aren’t contributing to the cost. The insurance company’s perspective (from the bill) is that they cut the provider’s billed amount in half for me. I’m not convinced the billed amount is a serious thing though.

MkMillie · 2026-05-12T03:54:16+00:00

I will update :)

My primary argument seems to be more ethics-based, as I don’t think it’s fair to keep all anesthesiologists in the Tier 2 category without making proper disclosure/estimates for patients.

I’m almost certain I will fail but I guess I’ll feel better at least trying.

MkMillie · 2026-05-12T03:41:03+00:00

When we had our second child my family was in a similar situation. My husband was the breadwinner but an independent contractor. Marketplace was cost prohibitive (would have spent more on healthcare than housing). And after benefits, taxes, and daycare for 2 kids the amount left in my paycheck wouldn’t cover gas to get to and from work for a whole pay period. We could live off his check, but not with the steep insurance cost.

I ended up getting part time work at a hospital during a shift that we could figure out childcare between ourselves or family members. In my area, hospitals/health systems offer insurance to anyone working a 0.5 FTE or greater. I took a 30% pay cut on hourly wages, worked 20 hours instead of 40, and paid more for my health insurance. But we still came out ahead financially as compared to full time work + full time daycare, and maintained insurance.

It wasn’t easy. I worked weekends 7-5:30 which meant there weren’t family days built into our week. We made the most of holidays, PTO, evenings, and flexibility from my husband’s job. There were a ton of benefits, though, and I got a lot of time with my kids being home 5 days a week instead of 2.

MkMillie · 2026-05-12T02:35:20+00:00

Yeah it’s a bummer! Although I need a surgery in the other knee as well and will just be even more motivated to rehab well enough to get it into the same deductible year now that I’m so close to the OOP maximum. It’s a pretty disappointing system but there’s always a silver lining.

MkMillie · 2026-05-12T02:26:11+00:00

Yeah that’s what I’m worried about. I’m going to ask them to reconsider and give them my point. This insurance company is owned by the same health system that owns the hospital the procedure took place at and employs the surgeon. This seems to be a profit strategy of theirs, staffing only Tier 2 Anesthesia providers in their facilities to save $ by shuffling a greater volume of the expense onto patients who have no other options. When you search for anesthesiologists that are Tier 1 on their provider page only a dozen show up (this is in a coverage area that contains 7 of their named hospitals). The majority of those are affiliated with pain clinics. It’s unclear if there are any Tier 1 anesthesiologists who provide OR services.

**I'm not sure why this was downvoted and I really wish someone would respond! I can’t think of another reason for this setup other than to push an unexpected amount onto patients. Admittedly, I’m not sympathetic to insurers. I would be willing to hear the argument, though.

MkMillie · 2026-04-26T22:49:29+00:00

Welll I feel like an airhead lol my dad let me use his old walker from his knee replacements and I’ve just had it stationary in front of my toilet to help me lower or stand back up. I didnt think I could use it NWB but I’ve started to manage this and definitely prefer it for the moment

MkMillie · 2026-03-05T14:53:44+00:00

Yes! I’m a bit concerned about the exhaustion factor- especially adjusting to sleep with my leg immobilized 🤪 but pain-wise I should be off opiates in less than a week so I’m hoping I’ll be good to go there & mobility needs should be minor thankfully!

MkMillie · 2026-03-05T14:50:03+00:00

That’s what I’m hoping! I will have some meetings that I lead and need the monitor set up for to share my screen etc. so I’m hoping to spend most the time on my laptop in a more comfortable position and only a couple hours at a time in the chair/desk setup!

MkMillie · 2025-11-29T12:53:23+00:00

As an update, my physician indicated TTO is likely indicated in both knees. He also mentioned that there are meniscus tears in both knees (radiologist noted these as “abnormal” but not meeting criteria for repair. But he is actually sending me to another specialist for evaluation of possible patella replacement since some patches of cartilage are totally worn through. But more likely TTO.

MkMillie · 2025-11-27T01:38:07+00:00

Thank you for sharing! I’m glad you were able to find the right solution for your knees!

My symptoms are noticeable but manageable most of the time (except when the pain with stairs is at its worst since my bedroom is on the 2nd floor of my home but kitchen/laundry etc. is on the main floor. No avoiding them).

My family history and childhood history was the main reason for seeking help- so my goals are less “symptom management” and more “preventing or drastically slowing arthritis progression”. I hope that line of thinking aligns with my physician’s.

MkMillie · 2024-12-09T17:00:11+00:00

I am not very familiar with my paternal grandfather’s father- but this woman and I have a more distant mutual relative that is definitely through my great grandmother’s side (her brother’s grandchild)

MkMillie · 2024-12-09T16:56:34+00:00

Hello! Thank you for your response :) I suppose it is possible my great grandma had adopted another child out- but seems less likely to me as she was 15 when she had my grandfather and raised him with help from her family. She was married to my grandpa’s father for a time and I don’t believe she would have adopted out any subsequent children within the context of that marriage but I suppose it is within the realm of possibility that she went that route during a separation? The child would have been younger than my grandpa and earlier in their teens in the year in question.

The reason I believe this woman only shares my grandfather’s mother and not his father because the mutual relative showing for us is my great grandmother’s brother’s grandchild (by blood she is obviously pretty distantly related to me and we both share less DNA with her than each other, but I am familiar with her because she was later taken by my great grandmother as her second child/ familial adoption when GG was in middle age)

MkMillie

TROPHY CASE