Knee pain and injuries in the adolescent population are common problems that are often seen in the primary care setting and in the specialists’ office. Knee pain can be a persistent problem not only for the patient, but for the treating physician as well. Chronic knee pain is often a diagnostic challenge; it responds unpredictively to both nonoperative and operative management. Surgery may be indicated in knee injuries to the patellofemoral joint in order to prevent worsening cartilage damage as well as recurrent instability. This chapter gives an outline of the most common pathologies and an approach to managing them. In general, most patellofemoral problems in the adolescent patient are benign and will resolve with time. They usually respond well to stints of rest, decreased sports-related activity, focused physical therapy, bracing, and anti-inflammatory medication. Although most chronic patellofemoral issues are treated nonoperatively, surgical intervention may be indicated in the presence of patellofemoral trauma. The most common patellofemoral disorders requiring surgery include tibial tubercle avulsion fractures, patella sleeve fractures, and patella dislocations resulting in osteochondral fractures.