Is a fitting worthwhile for me? I'm a guy with banged up knees. I'm trying to decide if it is worthwhile for me to splurge for a high-end bike fitting or go with a more ordinary fitting or skip getting a fitting altogether.

Background


One of my knees is missing a whole lot of articular &amp; meniscal cartilage.
I'm experiencing knee pain while going for relatively short distances (at the beginning of the ride &amp; after 10-12 miles).
I ride with Speedplay Frog pedals. I'm turning 49.
haven't had a fitting since January 2012.
I don't race or do group rides.
If my knees were solid, I'd like to do social rides or even go touring.
I ride a Surly LHT &amp; use it for commuting &amp; shopping.


It is more accurate to say I "used" the bike for those purposes. I'm pretty much not riding now because doctors have told me that knee pain=fresh damage. I have the option to get 1) a run of the mill fitting similar to the 2012 fitting from a well-regarded bike shop or 2) get a fitting from a physical therapist who works with racers, triathletes, etc. I've been to a lot of physical therapists &amp; surgeons without much result at this point. (Most seem have expertise with runners but none have any background with bikes.)

My last fitting was useful but I can't say it was ever quite right. I had joint issues back then which likely made the fitter's job impossible. I went back to the fitter a few times without much success. I mean, there are only so many adjustments you can make to the seat position right?

At this point, I'm looking to avoid throwing more good money &amp; time after bad. Maybe I should just get platform pedals? I keep seeing posts pointing to clipless pedals as causes of knee issues.

Perhaps I should just get a recumbent to limit knee strain?



Hi everybody,
Thanks for the rapid &amp; thoughtful responses. I was very interested to read about Power Cranks and Highpath engineering's split cranks. Here is some more background &amp; some responses to the recommendations:


I have 150 mm crank arms mounted. 
I am slow on the cadence. My core is weak so my pelvis wobbles at higher RPMS.
I’m sure I need work on my pedaling technique. When I try to pull up on the pedals, I end up with tendonitis behind the knee.
I’m happy to warm up with a gentle beginning to a ride but I’m getting pain pretty much pulling out of the driveway, before I have a chance to start the warmup.
I don’t really trust the physical therapist/fitter I found. He works with a sports medicine doctor I found &amp; both run a “factory” practice. They move you in &amp; out on the clock. I have some complex medical issues &amp; neither showed any appetite for exploring them during a recent evaluation. My sense is they are there to make money &amp; serve racers. I won't get either of them any publicity &amp; so am not useful. I've run into providers like this before. They have the skill to help but maybe not the will.
I’d be happy to see someone other than the PT/fitter but have had little luck in finding someone  with expertise in both bikes &amp; rehabilitation.
I did find a fitter at the bike shop who worked for a couple years as a physical therapy assistant. I could see him as well. 
Based on the above do any of you have further thoughts?
My advice is that you consult a sports medicine specialist, for example a physiotherapist, especially one who specializes in knees.

Once you find such a person, find a second. Sometimes you just don't get along with them. For me, I have to feel I can trust the person, and get honest discussion of the options and the pros and cons.

While bike fit may be an issue, it's only one approach. Other things to be considered are


gearing. Perhaps you just need to pedal at a higher cadence.
power and speed. Perhaps you're just trying to pedal too hard for that knee.
technique. Perhaps pulling up more would reduce the load on that knee.
crank size and cleat positions. These can both have an effect on knees.
warmup and cooldown. Getting symptoms at the start sounds like lack of warmup.


Find such a sports medicine specialist, and work with them as they evaluate your options and manage your progress.

Following your edit here are some additional points


wobbling pelvis and pain at the back of the knee are both symptoms that your seat is too high. 
just as an idea, you could try a topical warming agent (ointment) to help with the warmup. 


In an earlier version of this post I suggested Voltaren, recommended for me by my physio. I think that was unwise of me - you should obtain professional medical advice. Voltaren is an anti-inflammatory drug, available under prescription in the US. Some researchers warn against it's use.