Due to the multiple possible structural and functional causes, anterior knee pain represents a clinical challenge. A critical analysis with a careful history taking, clinical and imaging examinations is crucial in order to be able to make treatment decisions. The treatment of anterior knee pain should always be targeted to the cause of the complaints. Conservative treatment is effective in the majority of patients, especially when no clear intra-articular pathological alterations can be defined as the cause of the pain. A surgical approach is indicated particularly when clearly defined structural abnormalities can be identified as the cause of the pain and can therefore be correspondingly repaired or corrected.