Idiopathic anterior knee pain is a common and often serious clinical condition. The challenge of this condition lies in its complexity. Therapeutic outcomes are frequently disappointing and show a high tendency for recurrence. Risk factors are less about biometric data and more about prolonged pain duration and functional deficits. Malalignment and maltracking are predisposing factors that exert their effects within the context of dysfunctional musculature, central and peripheral sensitization, as well as emotional disturbances. Treatment should not only address the local problem but also consider systemic factors such as core musculature, trigger points, and psychovegetative state.