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This comes from noticing the similarity of the colors of the medics in the Prime Universe.
What if Knock Out were the offspring of Ratchet. Maybe he was a clone, or Ratchets own doctors faked the young mechs death and made it look like a stillborn. But anyway the mech was raised in secret by the Decepticons with the idea of “If the father is a great medic then surely their offspring would be also.” And slowly and surely he became their idea of a perfect Decepticon medic, with a few personality quirks of course.
Cut to present day and the Autobots find out whether by finding the records, or a Decepticon gloating about how they raised to medic. But how the Autobots react to this is up to you, I just didn’t want this to be lost in the ideas that flew through my head.