I hear you! Low Q-factor rules for my knees. My knees are even happiest riding my fix gear with its track crankset because the Q-factor is so low. Positioning cleats will only get you so far. Eventually you hit the adjustment limit or, barring that, your ankle/shoe hits the crank. I set all my shoes at the limit and with quill pedals, worn out many cranks rubbing them with my shoes. (I call them "worn out" when 1/3 of the material is removed. Edit: but love the lessened Q-factor 'till I have to replace them!)

Another place you can work with Q-factor is the bottom bracket. Not much you can do on the right side; chainline rules there, but different bottom bracket manufacturers have different approaches to the left side. Shimano makes BBs that are near symmetrical. The old Sugino BBs were much closer left side than right. That meant the Suginos had substantially less Q-factor but that one's foot placement wasn't symmetrical on the bike. My knees loved that! And as long as I didn't think about it, my body cared not a whit that my feet were cocked about half a cm to the right.

I haven't ridden the Sugino BBs for a few years. Been riding Shimanos for their availability, cost and all weather reliability. But I may go back to Sugino for my knees. I heard at a shop that they still do the asymmetrical BBs.

Ben