Let $k$ be a positive integer such that there exist positive integers $a$ and $b$ for which $$\frac{a^2+b^2+1}{ab+1}=k\tag{1}$$ Suppose that $(a,b)=(p,q)$ is the smallest positive integer answer to $(1)$ such that $p\geq q$ (in the sense that $p+q$ is the least possible). Therefore, $t=p$ is a solution to
$$t^2-(kq)t+(q^2+1-k)=0.\tag{2}$$
This is a quadratic equation so there is another root $t=r$. Note that
$$r=kq-p$$
so $r$ is an integer.
Suppose that $r<0$. Let $f_0(x)=1$ and $g_0(x)=1$. We want to show that for any non-negative integer $j$, there are polynomials $f_j(x),g_j(x)\in\mathbb{Z}[x]$ with non-negative integer coefficients such that
$$k\geq f_j(q)\geq 3j$$
and
$$p\geq g_j(q)\geq 3j+1.$$
Furthermore, $f_j$ has degree $j+1$ and $g_j$ has degree $j+2$ for $j>0$.
The case $j=0$ is trivial. We proceed further by induction. Suppose that $f_j(x),g_j(x)$ are known and satisfy the requirements. Then, we have from $(2)$ that $pr=q^2+1-k$ or
$$k-q^2-1=p(-r)\geq p\geq g_j(q).$$
Therefore, $k\geq q^2+1+g_j(q)$ and we can define
$$f_{j+1}(x)=x^2+1+g_j(x).$$
From $r=kq-p$, we get $kq-p<0$ or $p>kq$. That is, $p\geq kq+1$. Because $k\geq f_{j+1}(q)$, we have
$$p\geq q\ f_{j+1}(q)+1.$$
Hence, we define $$g_{j+1}(x)=x\ f_{j+1}(x)+1=x^3+x+1+x\ g_j(x).$$ Note that this construction guarantees that $f_{j+1}$ and $g_{j+1}$ has non-negative integer coefficients,
$$\deg f_{j+1}=\max\{2,\deg g_j\},$$
and
$$\deg g_{j+1}=\deg f_j+1=\max\{2,\deg g_j\}+1.$$
It follows that
$$\deg f_j=j+1$$
and
$$\deg g_j=j+2$$
for every positive integer $j$. It can be easily seen that $$f_j(q)\geq f_j(1)=\max\{1,3j\}$$ and $$g_j(q)\geq g_j(1)=3j+1$$ for all positive integers $q$ and for every non-negative integer $j$.
From the result above, if $r<0$, then $k$ and $p$ are arbitrarily large, which is a contradiction. Therefore, we must have $r\geq 0$. We want to show that $r>0$ is also impossible.
Suppose for the sake of contradiction that $r>0$. Then, $(a,b)=(q,r)$ is also a solution to $(1)$. By minimality of $(p,q)$, $p+q\leq q+r$, or $p\leq r$. That means
$$kq=p+r\leq 2r.$$
Hence, $r\geq \frac{kq}{2}$, so
$$q^2+1-k=pr\geq p\left(\frac{kq}{2}\right)=\frac{kpq}{2}.$$
Therefore,
$$q^2+1\geq \frac{k}{2}(pq+2)\geq \frac{k}{2}(q^2+2),$$
since $p\geq q$. That is,
$$k\leq 2\left(\frac{q^2+1}{q^2+2}\right)< 2.$$
Therefore, $k=1$. However, by $(1)$, AM-GM implies
$$1=\frac{p^2+q^2+1}{pq+1}\geq \frac{2pq+1}{pq+1}>\frac{pq+1}{pq+1}=1,$$
which is absurd. Therefore, $r>0$ cannot happen.
This means $r=0$, making $k=q^2+1$. In this case, there always exists a solution with the minimal solution $(a,b)$ such that $a\geq b$ being
$$(a,b)=(q^3+q,q).$$
All integer solutions $(a,b)$ such that $a\geq b >0$ satisfies
$$(a,b)=\left(x_{s+1}^q,x_s^{q}\right)$$
for some positive integer $s$, where the sequence $\left(x_s^q\right)$ is defined by
$$x_1^q=q,$$
$$x_2^q=q^3+q,$$
$$x_s^q=(q^2+1)x_{s-1}^q-x_{s-2}^q$$
for $s=3,4,5,\ldots$.