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@rab
My knees have been f@cking me right off ever since I went clipless a few months ago. Think I've finally sussed it now... probably a combination of saddle position and simply pushing too hard in the cold.
The guys in Brixton Cycles - all hail :-) - took one look at my position and said the saddle was too high - dropping 1cm and moving the saddle slightly forward has made the world of difference. Now make a point of getting up out of the saddle on hill climbs rather than pulling up with my knees. Also, carved some of my shoe sole away as this was preventing me getting the full float out of my Time Aliums. Somewhere in all that, things have sorted themselves out.
It's definitely worth taking the time to experiment and sort this out, it was kind of getting me down that even a 50-miler had me barely able to pedal with the pain.