Background <p>Patellofemoral pain syndrome (PFPS) is a common knee disorder associated with biomechanical abnormalities and impaired dynamic stability. While well-studied in younger populations, dynamic balance in middle-aged and elderly individuals with PFPS remains poorly understood. The Y-Balance Test (YBT) is a validated tool for assessing multidirectional balance and has been increasingly used in PFPS evaluations. This cross-sectional study aimed to compare lower-extremity dynamic balance using the YBT between symptomatic patients aged 40–60 years and asymptomatic controls.</p> Methods <p>Forty-nine patients with PFPS (symptoms ≥ 3 months) and 21 healthy controls underwent YBT assessment. Anterior reach asymmetry, composite score, posteromedial/posterolateral reach distances, limb symmetry ratio, and inter-limb difference were analysed with independent-samples t-tests.</p> Results <p>PFPS patients showed greater anterior reach asymmetry (4.4 ± 1.4&#xa0;cm vs. 2.4 ± 1.7&#xa0;cm; <i>p</i> = 0.03) and lower composite scores on the affected side (left: 92.1 ± 4.8% vs. 98.9 ± 3.7%; <i>p</i> = 0.02). Reach distances in the posteromedial and posterolateral directions were also reduced (<i>p</i> &lt; 0.05). Limb symmetry ratios did not differ between groups (<i>p</i> &gt; 0.05).</p> Conclusion <p>Middle-aged and elderly individuals with PFPS exhibit multiplanar dynamic stability deficits on the YBT despite preserved inter-limb symmetry. These objective impairment findings support incorporating targeted balance training and kinetic chain exercises into rehabilitation protocols for this age group.</p> Clinical trial registration <p>ClinicalTrials.gov Identifier: NCT07068984</p>