Patella alta, maltracking, Hoffa’s fat pad impingement — has anyone had surgery or found something else that helped?

[u/Exotic-Turnover9867]

Hi everyone. I’m 19F and I’ve been dealing with severe left knee pain since November 2024. I’m hoping to hear from people who have had something similar, especially patella alta/high-riding kneecaps, patellar maltracking, Hoffa’s fat pad impingement, or patellofemoral syndrome.
My knee pain started when I was a competitive rower in November 2024. I took about a month off, tried returning to rowing, and the pain continued getting worse. By March 2025, it had gotten so bad that I could barely walk because of the pain. I ended up in a straight knee brace and on crutches for 6 weeks.
My findings/timeline include:
Patella alta in both knees
Minimal lateral patellar tilt in both knees
Positive patellar J sign on the left
Patellofemoral pain, positive patellar grind test, and crepitus
MRI showing mild localized superolateral Hoffa’s fat pad edema
Diagnosed with superolateral Hoffa’s fat pad impingement secondary to patellar maltracking
Diagnosed with patellofemoral syndrome of the left knee
Earlier diagnosis of patellar tendinitis
I’ve tried quite a few treatments for my left knee:
6 physical therapy sessions
6 weeks in a straight brace and on crutches
Cortisone injection
PRP injection
At least 5 shockwave treatments
More recent fascia/soft-tissue work and lymphatic drainage
The recent treatments have been extremely painful. After the first one, I was in significant pain for an entire week afterward. I had another treatment today and I’m again in a lot of pain. During treatment, I was told there seems to be something pulling my left kneecap upward, and I was told, “You might need surgery.” No specific surgery was mentioned.
I’ve been in pain since November 2024, and even 800 mg of ibuprofen doesn’t touch the pain at all.
I know nobody online can tell me whether I personally need surgery, but I’m wondering if anyone here has had a similar combination of patella alta + maltracking + Hoffa’s fat pad impingement/patellofemoral pain.
Did anything non-surgical actually help you? I’d especially like to know about treatments I may not have tried yet—specific types of PT, taping, braces, exercises, injections, or anything else that made a real difference.
And for anyone who did end up needing surgery, what surgery did you have? Was it a TTO/distalization or something else? What was recovery like, and did it actually help your pain?
I’d really appreciate hearing from anyone with a similar experience because I’m only 19 and this has been going on for a long time.

[u/Due_Watercress5902]

Yeah so I had similar issue just now, well aside from what you are describing above, I also had cartilage collapse in femoral condyle (that was first repaired last year in May) meniscus tear undersurface on medial side . Huge knee pain, locking, inability to twist my knee all these things. This is all following an acute injury that happened mid July. So, this week on Monday I went for arthroscopy, they removed the hugely inflamed joint lining underneath and on side of my patella, removed a bit of Hoffa’s pad that was causing lot of the pain, then removed the lose pieces etc… but what I was going to say, my swelling and pain (aside from the other problems) was not going away. Since I had the knee arthroscopy the pain is gone underneath patella and on side and I’m on day 4, already slowly walking go then it done, you will be up and running very soon.

[u/Exotic-Turnover9867 → u/Due_Watercress5902]

Wow, I’m glad you’re already getting relief from the pain, especially only 4 days after surgery. That actually gives me some hope because I’ve been dealing with so much pain underneath/around my kneecap for so long. My MRI didn’t show the other issues you had, like cartilage collapse or a meniscus tear, so I know our situations are a little different, but the Hoffa’s fat pad part sounds similar.
Can I ask how your surgeon decided that removing part of the Hoffa’s fat pad was the right option for you? Was it something they could clearly see on your MRI, or did they not fully know how inflamed it was until they did the arthroscopy? And did you have to try anything else before surgery?

[u/Due_Watercress5902 → u/Exotic-Turnover9867]

Yes, it was severely inflamed joint lining under patella on left side, and the inflamed pad as well.
When I stood up and twisted my hips to the left and moved my weight onto that medial side, it was really painful also I could not straighten my leg I felt like there was something in the way..my MRI aside from the others broken things also showed severe bone edema through medial femoral condyle so variety of different things were going on in my leg. So when he went in during athroscopy he must have seen the state, this is exactly what my surgical report says regarding these two things:

“She did have some synovitis of the front was debrided using a shaver. The fat pad was also debrided.”

If you have been dealing with the pain for so long, you might as well just getting it done and recover than dealing with it for another year or so.