So sorry you're having such issues! As someone who has had a lifetime of knee injuries and many surgeries, I am in total sympathy with you. I've had reconstructions, ACL tears, medial and lateral meniscus tears, and arthroscopic surgery just to clean up the joint. As with you, my issues stem from patellofemoral syndrome (and too much running and tennis when I was young). My issues have gotten considerably better in the past 15 months from a combination of losing a lot of weight and working out 3x per week with a good trainer--but it's been a long slow road. For me, I think that increasing core strength, as well as strengthening quads and hamstrings, getting a good balance has made all the difference. I still get a fair amount of swelling after a long ride, but no significant pain anymore. I also worked long and hard on getting cleat position correct--9% float on one and 4.5% on the other.

The surgery is not bad, but I don't think it's a magical fix. For me, it took longer to recover than the orthopedists said. Each time (5x arthroscopically, both knees), it took a couple of weeks on crutches--not the 3-4 days they said. However, I wasn't in the best shape physically those last couple of times. If you're physically fit otherwise, it might be less time.

I would say if you're still having that much pain after a couple of months of PT and restricted activity, then the arthroscopy might be something to consider. Talk long and hard with your Dr. Disclaimer--I'm not a physician or a physical therapist, just someone with similar issues and experience with that type of surgery.

I hope all goes well. Good luck!