We review the current status of knowledge in the field of pathogenesis of anterior knee pain in the young patient. Emphasis is placed on newer findings. We have developed what we call the "neural model" as an explanation for the genesis of anterior knee pain. According to our studies we hypothesize that periodic short episodes of ischemia in the lateral retinaculum could be implicated in the pathogenesis of anterior knee pain by triggering neural proliferation of nociceptive axons (substance P-positive nerves), mainly in a perivascular location. Our findings are compatible with the tissue homeostasis theory widely accepted currently to explain the genesis of anterior knee pain.