Ok I've got an 03 dodge ram 1500 with the 4.7l motor in my garage right now. I'm working on it for my friend. He's complaining about a knock coming from the bottom end. I've changed the connecting rod bearings and found they were fine, probably the cleanest lower end I've ever seen. Bearings looked new.
Didn't have an indicator on hand so I didn't check for end play in the crank, not did we change the thrust bearings. He didn't want to mess with it. The truck has 225k miles on it.

 

Can't help with the knock but at 225,000 miles is it even worth trying to fix? Now if you called me when I worked warranty I'd say I will pay you a couple hours to tare down and diagnose. Then go from there.
Trans is probably not far behind.

 

Did you check oil pressure with manual gauge???