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Patellofemoral (PF) pain, a subset of anterior knee pain, presents a particularly challenging diagnosis due to the multifactorial etiology. Within this group, assigning the patient’s symptoms to a patellofemoral cartilage lesion is indirect; that is, a diagnosis by exclusion as hyaline cartilage is aneural. In addition, these PF compartment lesions are often in conjunction with various comorbidities, for example, malalignment and/or instability. In light of these factors and the high shear and compression stresses at the PF compartment, patellar and trochlear chondral lesions require unique treatment considerations from the tibiofemoral compartments. A thorough understanding of the various cartilage restoration techniques available is necessary to select the best option for the individual patient/knee/lesion noting that there is overlap of techniques’ applications. In addition, failure to address and correct associated comorbidities may jeopardize the outcome of any cartilage restoration procedure. That is, the key to achieving optimal outcomes with PF cartilage restoration is to select the best cartilage treatment for the particular setting and to concomitantly optimize the PF biomechanical environment and stability.