motorthings

I am 47, and started having knee surgeries in the 70s for CP (due to Ehlers Danlos - Hypermobility type)
I've been through PT too many times to count, and know what works for me...maybe it will help you.

Good bike fit is CRITICAL, so don't worry about paying 200-300 for it, just make sure you are going to a fitter with a good rep who knows how to use the tools (i had a retul fitting done and it was far and away the best $ i've spent on cycling)

Surgery can be very helpful, as long as it is needed, and you have a good surgeon, and you rehab correctly. I have had a roux-gothwaite, multiple arthroscopic (clearing out chunks of cartilage), fulkerson osteotomy, and most recently a patellofemoral joint replacement.

each time I went through PT or had surgery then PT, I was able to get back on the bike and ride and race again. The key is not overdoing it as you build back up the strength and coordination, and (for me) being diligent with foam rollering and massage.

in the next 10 years i'll need at least one full knee replacement, and will be back on the bike. just be smart, patient, and keep riding.

stevelewis

Thanks again for the input you all have contributed. I've found an astonishingly good article that I'm linking below. Despite the focus on running, I think it is probably of great value to cyclists and anyone suffering from knee pain. I hope everyone finds this as edifying and fascinating as I did. (I have internally rotated femur bones like the article mentions, so it felt especially germane to my particular situation!)

Running writings: Injury Series: Uncovering the role of hip strength and mechanics in the cause and treatment of patellofemoral pain syndrome