Just throwing it out there, and not sure if it would pertain to you. At the beginning of the season I started having some really bad knee issues in my knee that I don't really have problems with. Messed with my fit which didn't seem to help, and finally went and got a professional fit again. As it turns out, I just needed new cleats. My old ones were so rough and a little bowed from tightening them down, that they weren't allowing for any float and effectively locking my leg in place. New set of cleats, and some ships to keep everything level corrected the problem.

Try adjusting your cleats. I had a similar problem, a simple tweak to the cleat fixed it.

I guess i will give that a shot, strange they haven't caused me issues before

A couple of things will cause my knees to hurt. (1) if I let me knees wander out at the top of the pedal stroke, instead of staying in line parallel to the bike. (2) if I push too hard for a long time. Either increasing cadence or lifting more helps this.

It's not so much general knee pain I am concerned about. It's the acute and sorvifuc nature of this hot spot that I'm trying to figure out

x2. New bike and new shoes; I had to adjust my cleat where my heel was turned a bit further out.