I would think that at 253K+ miles you'd probably be needing a heavier oil. What weight oil were you running with the synthetic? 5W30 seems a little light to me. Can you tell where the knock is coming from? As soon as it starts, is it a real deep tone knock, or is it a higher pitched knock? Can you tell if the knock is at engine RPM (probably lower end), or half engine RPM (probably top end)? Deep, low pitch knocks are usually main bearing (deepest tone) or maybe a rod bearing (a little higher pitch), piston noise is more like a rattle than a knock, and top end (lifters/rocker arms) are usually a higher pitch, mostly like a clicking sound rather than an out and out knock. With that many miles, I'd probably put my money on main/rod bearings, as a good synthetic will normally prolong engine life and keep the top end in good shape. The bottom end takes the most beating, especially if you repeatedly put a lot of load on the engine.....mountain climbing, towing, lots of WOT use, etc. It could also be that it is near time to give some serious consideration to major engine work, if you want to keep the vehicle. Without hearing the noise, it's hard to figure out, but for starters, if they've put in a lighter weight oil, I'd switch to a heavier oil and see what happens. At best, this would just cover up a problem that is probably already there. Good luck and let us know what you find out.