Sounds like it's been frustrating for you. Especially having thrown a ton of treatment at it....hoping one will stick.
Patello-femoral pain, ie any pain around the patella....TYPICALLY isn't a surgical case. Lateral release surgery has very mixed outcomes and really aren't performed much anymore. A general knee scope isn't any better than conservative management.
Often with these cases, it's about load management and a painfully boring/tedious progression with your running as your tissues adapt/get stronger. You mention doing some hip strength stuff as that is often prescribed for PF pain and there is good evidence to support this in clinical studies....but there's often more to the puzzle. Pain science tells us that a long "persistent" bout of pain (decades for you) is more about sensitive nerves vs tissue damage at this stage (another reason to avoid surgical intervention)
Often with patello-femoral pain in runners, improving dynamic quadriceps strength in that 0-45 degree range of knee flexion is key. Maybe you did some of this prior, but it does take consistent work before you can load up running miles. Sometimes it does take some research finding the right clinician (one who sees a ton of runners and knows running mechanics). Obviously, it's tough to know exactly how you present. Hope this gives you some help
Thanks PTinAZ. It has been frustrating! Frustrating for the physios I've seen as well but, after a while, they kind of run out of ideas.
I don't have classic patello-femoral pain. My knee can ache in general, but the pain is most definitely localized to the lateral side of my knee, sometimes around the fibular head. I know clinical studies have been mixed for hip strength improving ITBS. I haven't done as much quadriceps work as glute work though, so I will start adding that in more.
My understanding that ITB surgery is different to a lateral release surgery. They now either make a small 2cm incision to the ITB or there are arthroscopic procedures to remove the synovial recess from under the ITB, both of which are day surgery and seem to have high (85-95%) success rate.
As a doctor, but not a sports medicine specialist, I would have to say have anyone questioned the diagnosis of what is causing your knee pain? Bias is common in medicine and there are many things that can potentially appear similar to ITB etc. I don't think any surgeon would even go near you at the moment without imaging (MRI in particular, and have it read by proper musculoskeletal radiologists) and other conservative options. Surgery is only useful if it is fixing a known underlying issue (OK, have you read the studies where they did sham knee scopes and showed no difference in outcomes versus those who had been scoped)....not saying it should not be an option, but it needs to be the right option for the right diagnosis.
I do believe there could be something else causing it. I went to an orthopedic surgeon and had an MRI because of a 'dynamic snapping biceps femoris', where my biceps femoris (long head?) flicks across my fibular head when I squat past 90 degrees. When I found this out, and saw that there are a handful of clinical case studies showing that people who have it present with lateral knee pain, I thought I had found the silver bullet of my knee pain. My MRI only showed inflammation under the ITB and no other pathologies, and the surgeon was quite adamant that my snapping BF was not the reason for my knee pain because it didn't cause me pain in itself. I still question whether that is the case -- surely, over many miles, small idiosyncratic movements of the BF could cause irritation? The snapping BF does improve with deep glute stretches, and incidentally that is what improves my lateral knee pain when running the most.