There are clear differences between men and women with regard to anterior knee pain. Anatomic factors including increased pelvic width and the resulting excessive lateral thrust on the patella are significant in female predisposition to anterior knee pain. Effects of estrogen on connective tissue synthesis have been noted, but there is no clear mechanism by which this would affect anterior knee pain. Postural and sociologic factors such as wearing high heels and sitting with legs adducted can influence the incidence and severity of anterior knee pain in women.