Knee osteoarthritis (OA) is a prevalent disease afflicting elderly people. As the knee joint is tri-compartmental, numerous radiographic patterns of disease are possible. The patellofemoral joint (PFJ) is one of the most commonly affected compartments. Although PFJ OA is frequently observed, this particular disease sub-group has gone largely unrecognised. Recent research suggests that not only is the PFJ an important source of symptoms in knee OA, but also that afflicted individuals demonstrate disease features distinct from those observed in tibiofemoral joint OA. This has implications for the assessment and treatment of patients with PFJ OA. This review summarises the evidence suggesting why PFJ OA should be considered a distinct clinical entity and how it may best be managed using conservative, non-pharmacological treatment approaches that are targeted to the PFJ. Interventions such as patella taping, patella bracing and physiotherapy have the potential to alleviate joint stress and symptoms for people with this condition.