Background: Knee pain is a common complaint among individuals, and accurate diagnosis of the underlying pathology is essential for appropriate management. Ultrasonography has emerged as a promising imaging modality for evaluating knee pathologies due to its accessibility, cost-effectiveness, and real-time imaging capabilities. This study aimed to compare ultrasonography with true fast imaging with steady state precession MRI images in assessment of femorotrochlear cartilage in anterior knee pain. Methods: This cross-sectional observational study included patients with anterior knee pain. Complete history taking, general clinical examination, and NPRS assessment were performed. Ultrasonography of the affected knee joint was conducted using a linear probe (7-12 MHz Logiq P5). Subsequently, true fast imaging with steady state precession MRI images of the same patients was analyzed. Results: The study included patients with a mean age of 34.85 years, with 57.7% being females. Ultrasonography and MRI findings were categorized based on severity and associated features. Positive and negative predictive values, as well as sensitivity and specificity, were calculated for each finding. The results demonstrated significant agreement between ultrasonography and MRI findings, with notable sensitivity and specificity values for most categories. Conclusion: The study revealed that ultrasonography and MRI exhibit distinct strengths in detecting femorotrochlear cartilage abnormalities. Ultrasonography demonstrated high positive predictive values in most findings, while MRI exhibited excellent specificity. Sensitivity varied between the two modalities for different cartilage grades. Both techniques demonstrated overall agreement in identifying cartilage structural changes, albeit with varying diagnostic performance in specific grades.