Now I see this post is almost a year old, but still for what it's worth, I just looked at some of your old posts diggersmom and I see that you mention patella alta and shallow trochlear groove, but I see no mention of ever having had a CT scan or any mention of a malalignment like knock-knees or bowed legs. The CT scan will indicate if there is any rotational deformity of the femur and/or tibia, which is always a possibility especially when problems start at a young age. It will also tell the TT-TG distance, indicating if a TTT to move the patella medially would be beneficial. A standing full leg length x-ray (hip to ankle) will let on if there is any knock-knee or bowed-leg malalignment. Since you mentioned patella alta before, I wonder what kind of TTT the OS was suggesting, as distalization of the TT is the kind that addresses patella alta. Best to see a patella specialist that will rule out these factors.