Patellofemoral pain is a multifactorial problem. No single successful solution for problems related to the patellofemoral joint has been identified. One needs to consider the interaction of all of the factors affecting the extensor mechanism. Evaluation begins with a careful history, physical examination, and appropriate radiographic studies. Arthroscopy can provide additional information regarding the condition of the articular cartilage, patellar tracking, and the presence of other intra-articular lesions. Conservative treatment is the cornerstone of management and is effective in more than two-thirds of patients, making surgical treatment necessary in only a minority of instances. ALRR, although not an innocuous procedure, has an acceptably low complication rate and provides predictably good results when used in properly selected patients.