For many years, anterior knee pain and chondromalacia patellae have been used interchangeably. Currently, however, patellofemoral malalignment is not considered the only culprit for anterior knee pain, which was thought to be accounted for earlier. Some patients with normal patellofemoral alignment may suffer from anterior knee pain, whereas there are some others with patellofemoral malalignment without any complaints. Neuroanatomical-based studies showed that lateral retinaculum might have a key role in the underlying pain and ischemic episodes due to tension might result in neural proliferation of nociceptive axons, primarily in a perivascular location. Lateral retinacular release is suggested to be beneficial in the pain relief, by not only correcting the malalignment, but also inducing patellar denervation. Neural model defined for the anterior knee pain is another mechanism which should be kept in mind as well as patellofemoral malalignment.