Anterior knee pain following reconstruction of the anterior cruciate ligament is a problem that has plagued many patients. After extensively studying patients with this problem and comparing them to those that do not suffer from this entity, we have concluded that this is most often due to a loss of full hyperextension. Prevention of this by proper preoperative, intraoperative, and postoperative management can be successfully performed. Prevention should be the number-one concern. If anterior knee pain after ACL reconstruction does occur, the symptoms can usually be alleviated through nonoperative means. Occasionally, surgical intervention may become necessary. Other causes for this pain syndrome are rare but with proper evaluation can easily be differentiated and treated.