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Patellofemoral disorders, especially patellofemoral pain with degenerative arthrosis, are difficult to treat unless the physician understands the importance of a thorough history, physical examination, and radiographic imaging. The presence of patellofemoral arthrosis does not always cause pain and disability. Likewise, patellofemoral pain and disability can exist without arthrosis. Although nonoperative treatment is the mainstay and the most successful of treatment options for patellofemoral pain with arthrosis, surgical treatment often is required. Surgical options include arthroscopic debridement, abrasion arthroplasty/microfracture, cartilage transplantation, tibial tubercle anteriorization (Maquet osteotomy), anteromedial tibial tubercle transfer (Fulkerson), anteroproximal tibial tubercle transfer (DeLee), patellar resurfacing, patellofemoral arthroplasty, total knee replacement, and patellectomy. The authors review operative treatment options for patellofemoral pain with arthrosis with an emphasis on grade III or IV Outerbridge changes, with specific attention to the results that have been presented in the literature.