elcruxio, I've had chondromalcia patellae the past 47 years; since mid-way through my brief venture into road racing. My knees make it very clear that they do not like wide Q-factors at all. They have never seen a Q-factor that felt too small. (There probably is one but it may not be achievable on a conventional bicycle.) They love 135s. (Velodrome fix gears.) 145 is OK. 155 works for around town bikes. I've been observing this since the late '80s as the super straight Sugino and TA cranks fell out of favor and Q-factors started marching up.

My best custom is set up triple so I can climb anything on these knees. It started out with nice Shimano 105 crankset. But my knees weren't entirely happy. In fact, I started taking my fix gear up the same hills and found my knees liked that better! So I re-did the good bike. It now has ancient, straight Sugino cranks from the old "10-speed" days, a super narrow Phil Wood BB. Not an easy process, I had to install "pins" to keep the chain from falling into the gap between rings. But the Q-factor is way down and my knees love it.

So - I can listen to my knees that make it very clear that I have a choice. Low Q-factors or those modern replacement knees. If I were to follow that "research" and take the Q-factor doesn't really matter approach, I'd have a pair of neat scars on my knees. And after that, you would probably be right.