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Hi boing, you are indeed correct that PA usually comes with pain. But that happens when PA is caused by unexplained factors such as tight muscles or something. In our case, this is caused by the anatomy of the healed tendon. PA is just a term and the 20% variation you are describing is done using the Insill Salvati ratio which is the ratio of the length of the knee cap to the length of the patellar tendon. With good quad control and strength a slightly higher kneecap wont affect to in any way, This is all what my doctor told me. He has done several patellar tendon repairs. Also I am just curious to see how your patela alta compares to mine. If possible, put a pic up showing your two kneecaps. Hope the recovery goes well.