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It seems some in the USA are confused, the knighthoods dished out by UK politicians to Americans in HM's name are real not honourary.
The only difference is they do not have the right to use to title sir or dame because they have not knelt to get the tap on the shoulder with a sword not being subjects of HM.
But any American taking British or some Commonwealth countries citizenship who have HM as head of state can use the title Sir or Dame
So yes they are real, of course the vast majority are dished out by UK politicians so are worth as much as politicians are.