possible leg length problem more so than OA

For over 30+ years I have had a reoccurring sharp pain near the upper/lateral patella that would come and go. At times it would feel like an IT band problem and the pain would come when walking and the knee would bend. This pain would go away in three to five days and I could go back to squatting weights, hiking, doing treadmill etc. with no problem. Now in my older age of 68 the condition is chronic, weird things like doing wall sits gives instant relief after for a short period of time, working legs in the gym gives me relief for about a day and then back to hobbling around.
I have always squatted heavy weight and have one leg, right leg, stationed behind and out of line with the left leg, this is where I have been most comfortable. Ortho says it's OA and I have questioned this because the x ray shows a distinct gap between bones and he tells me there is no reason to have an MRI
Could this be a leg length problem? would an MRI give more information as to what is happening at the knee?

Thanks,

Sorry about your trouble.
Simple measure: - This might benefit significantly from botulinum toxin injection into Vastas lateralis quad muscle.
Kesary, Y., Singh, V., Frenkel-Rutenberg, T. et al. Botulinum toxin injections as salvage therapy is beneficial for management of patellofemoral pain syndrome. Knee Surg & Relat Res 33, 39 (2021).
https://link.springer.com/article/10.1186/s43019-021-00121-3

they used 500 units of Dysport botulinum = 200 units of Botox which seems like overkill. If it is not bad all the time then 100 units Botox might do but is $400 in my country.

Good luck