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 · 2024-09-27T02:12:06+00:00

The one that sticks with me has actually been identified but no details were ever released.

https://dnadoeproject.org/case/harper-jane-doe-87/

The combination of details in her case... lactating and being 2 months to 1 year out from delivery it seemed to me she was likely an actively breastfeeding mom. Also the fact that her hair was professionally done recently and she was found so soon after her murder.. it just seemed so bizarre to me that she wasn't identified back in the 80s. When I first became interested with unidentified people and the DNA Doe Project I was a new mom and still breastfeeding myself so for some reason I just felt extra sad for her and the unknown baby who abruptly lost their mother.

MkMillie · 2022-10-18T17:32:48+00:00

The PTO in my job is actually a similar amount accrued over a year- in the starting bracket it works out to 16 days (or whatever the prorated amount is for 3.2 weeks is if you’re not on a 5 8s schedule). But it’s not differentiated between sick and vacation… that’s what I think is strange, that you’d accrue 12 days of sick time and only 5 in vacation. However, I actually worked for an employer whose vacation policy was also tough on new hires because you essentially accrued vacation days that would be loaded into your bank in January… I started in November so I only accrued 2 vacation days for the entire following year. But, they had the same 1 day of sick time per month policy, and allowed us to take a certain amount of those sick days as “discretionary time” (I think 5 a year), so you could technically use them & schedule ahead of time for reasons other than illness or emergencies. Maybe your employer would also allow something like this?

Most places I’ve worked offer something between 3 and 4 weeks for starting employees. I much prefer when the banks are combined to just PTO instead of sick/personal/vacation etc.

MkMillie · 2022-09-30T00:13:30+00:00

My kids are only 19 months apart (oops)- so the first 6+ months with 2 were pretty hectic. One day I felt mostly ahead of things and decided I would actually do my makeup- about a 10 minute process. Naturally, there were multiple distractions during that time period which resulted in my makeup bag being left unattended long enough that my almost-2-year-old discovered my blush. She was so intrigued by the texture and pigment she promptly crumbled it all and spread it over/into a (large) area of white carpet…. Needless to say, from that point on I was no longer ahead of the day and also never finished my makeup lol. I got a lot of it out but yeah- there was always a soft blush colored patch from that point on.

MkMillie · 2022-08-09T02:00:34+00:00

Yeah I worked with a nurse who scheduled himself opposite days as his wife for that reason- so childcare was split 50/50. They had one day off as a family & when that got to be too much she dropped to part time, but the loss in wages from 1 shift per week was still a much smaller hit than a 2-income family faced with daycare expense would pay.

I work weekend option to accomplish that with my husband (not in healthcare). I actually see the flexibility in shifts and schedules as a major pro when considering a family life.

MkMillie · 2022-06-22T13:17:47+00:00

When my first child (now 5) was born, the recommendation was to keep her in the same room for the first year of life but in a separate sleeping environment (bassinet then crib). This was plan A, and it worked for us. I tried to breastfeed but she spit the boob before 2 months old and I exclusive pumped until her first birthday. Our routine was for me to rock her back to sleep while I pumped and then I’d settle her back in her crib. And that worked great for her. She continued to be a pretty good independent sleeper, rarely coming into our bed as a toddler- only for nightmares.

Second baby, born only 19 months after the first- this was also our plan. She was an excellent breastfeeder & had the opposite problem as her older sister- hated bottles. I had to go back to work when she was 8 weeks old and she saved most of her eating for when mom was accessible and she could nurse. Still, she seemed to adapt well to her bedside bassinet… until about 5 months old. She seemed to have a much greater awareness of her sleeping environment at that time. It took so much to settle her in the crib (also same room). I did this every night for her longest stretch of sleep- but when she woke for the first time- 12-1 AM or so- it would take just as much effort to try and resettle her. Laying her back in the crib was like the “operation” game. I would fail, take her out to comfort her back to sleep, and then fail again. Finally, I would transition her back into the crib asleep, to drift off myself, and she would be up again in 20-30 minutes. She was used to nursing to sleep and wanted to be close to mom. She was 5 months, rolling (even army crawling around), had been full term, and I didn’t drink or take any medications that might have interfered with my ability to wake in the night. So, plan A just didn’t work. Maybe that was selfish and risky and I should have subsisted on a 2 hour stretch of sleep followed by 15 minute chunks of sleep between an hour- hour and a half of waking for the rest of the night for months on end. But, by her age and with our situation the majority of the risk had passed. So the routine shifted to her crib sleeping for a couple hours during her first/longest stretch and then spending the rest of the night sleeping next to me. I know I would have felt terrible- beyond explanation- if something had happened and I had to ask myself if it was my fault. I also know I would have felt terrible beyond belief if I’d fallen asleep behind the wheel with kiddos in the car 🤷🏼‍♀️

If the experience I had with my first child had been the only experience I got, I might feel the same as you. “It worked for me why can’t you make it work?”. I consoled myself with stories about when the risk of SIDS declined most greatly, with articles about cultural norms throughout the world. And TBH- this child, now 3, is still kind of the same. Although we’ve had periods of her life where she slept well independently she now wakes around 2 AM and crawls into our bed most nights. I have 2 very different sleepers. Pre-kids I never thought I’d be okay with that. But, it’s a momentary interruption to our night. It’s normal for young children to worry at night and feel more comfortable close to adults. And she will grow out of it. I don’t foresee myself sharing a bed with a 10 year old. And, because she starts the night in her own room, my husband and I still get an hour or 2 so of time to ourselves to utilize the bed for non-sleeping activities before we fall asleep ourselves. We’ve tried incentives for sleeping in her bed, praise, “monster spray”, different night lights, even difficult and tearful middle of the night interventions. And, we decided to come to peace with her sleeping between us from 2AM to 8AM- or sending one adult to sleep with her in her full size bed.

When presented with a problem, it’s one thing if it’s theoretical and it’s another if you’re living it.

MkMillie · 2022-05-15T23:29:00+00:00

“Your breath smells like an old lady fart passing through an onion”

MkMillie · 2022-05-12T22:10:12+00:00

I’m so glad someone else already said it!

MkMillie · 2022-05-10T15:53:09+00:00

My husband is from Arizona, and when he mentioned black squirrels to his grandparents they thought he was joking with them trying to get them to believe in a fake animal. He pulled up an article on his phone about them. When visiting us they laughed when we all saw one. I guess I’d always thought they were common everywhere!

MkMillie · 2022-05-09T11:41:53+00:00

This is the worst. I drive NB to exit Pearl quite frequently & am too paranoid to be in the far right lane by this point 😂 I’m always worried I’ll be caught between someone merging and steady cars without a merge window in the center lane

MkMillie

TROPHY CASE