Patellofemoral arthritis is a musculoskeletal common complaint. It is the most common diagnosis of anterior knee pain presenting to sports medicine and physiotherapy practice. When the disease is in its early stages, a careful and complete course of nonoperative treatment may provide sufficient pain relief and functional improvement. If surgery is required, limited soft-tissue procedures such as arthroscopic lateral release and debridement may work well, if the lateral portion of the joint is primarily affected. Tibial tubercle transfer, particularly anteromedialization, is a powerful way to correct malalignment and offload the lateral and distal parts of the patella. The indications for tibial tubercle transfer may expand if it proves to be a successful adjunct to cartilage resurfacing procedures. For more severe disease, patellofemoral arthroplasty has evolved into a safe and reliable alternative.