Patellofemoral disease is one of the most controversial management issues in orthopedic surgery. Nonoperative management as a prerequisite first line treatment is successful in the majority of cases. However, a small subset of patients with persistent pain after adequate rehabilitation will be potential candidates for surgical intervention. Careful assessment of the underlying pathomechanics is critical for a successful outcome; these include malalignment of the extensor mechanism, trochlear dysplasia, soft-tissue imbalance, and chondral damage. As the pathology is multifactorial, the planning and treatment must be multifaceted. With careful patient selection, the options of titrated limited lateral release, restoration of MPFL function, tibial tubercle osteotomy, cartilage repair, and patellofemoral resurfacing provide improved functionality and pain relief for the young patient suffering from patellofemoral pain.