The only pedal my ortho will allow me to use is Speedplays.

I have chrondomalicia in both knees.

I just had a bike fitting and the person who did the fitting said the best thing to do is check alignment and if there's a problem correct the alignment, with orthotics, shims, etc. Then work with the best pedal.

I have cycling orthotics and Speedplays and ride problem free.

As far as I'm concerned I'm better off letting my knees fall in their natural position and keep them happy.

I'm rehabbing a torn ACL/MCL and could still unclip my weak leg from the Speedplays.

Proper training, ie. building up base miles, weight lifting, spinning a high cadence also keep my knees happy.