A dilemma exists in choosing the imaging study for patellofemoral patients that provides the most definitive information and is most cost effective. Society has asked that practitioners develop and order the most accurate tests for their patients in addition to the ones that are the most cost effective. Formerly, plain radiographs were the only imaging modality at a doctor's disposal, whereas now a wide array of studies is available. The challenge then is to order the least expensive test that will provide the necessary information. Very often this is the plain radiograph; however, some of the more expensive modalities such as magnetic resonance imaging and computed tomography scan can be cost effective when they clearly affect treatment decisions. In this article, we review the currently available patellar imaging techniques, as well as those that may be forthcoming, along with our opinion concerning their place in our armamentarium.