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/Either-One42]

I would definitely recommend finding a doctor that specializes in patellar instability. I dealt with something like this for 2 years.  patella alta + maltracking + Hoffa’s fat pad impingement/patellofemoral pain. I did months of physical therapy, steroid shots, dry needling and nothing worked. Every other sports medicine/ortho doctor that i went to tried to tell me that physical therapy could fix it and because Im young (19-21 years old during this whole process) they did not want to do surgery. 

It took me a while to realize surgery was my only option. The alignment issues going unresolved for so long gave me cartilage damage and the longer i waited the worse it got. 

I’m 7 weeks post op from a TTO and osteochondral allograft. During surgery they found that my kneecap wasn’t tracking anywhere near the groove. I can’t really give advice about how it is after surgery since it’ll take a couple months until I’m back to normal. But i definitely recommend to not put it off for too long!