Background: Patellofemoral syndrome (PFS) is a common cause of anterior knee pain, often linked to patellar malalignment, muscular imbalance, overuse, and poor patellar tracking. While most patients respond well to conservative treatment, a subset continues to experience persistent symptoms. Case Report: A 24-year-old athletic female presented with a 6-month history of bilateral anterolateral knee pain aggravated by squatting, stair climbing, and downhill walking. Examination revealed patellar tendon tenderness, weak vastus medialis obliquus (VMO), tight hamstrings, and patellar maltracking, more pronounced on the right. X-rays were unremarkable. She was diagnosed with PFS and managed with anti-inflammatory medications, targeted physiotherapy to strengthen the VMO, and modifications to her training regimen. At 6 months, she reported improvement; however, persistent bilateral knee pain remained at her 12-month follow-up. Conclusion: This case highlights the role of VMO weakness and patellar maltracking in persistent PFS. Although conservative therapy may offer partial relief, some patients continue to experience chronic symptoms, underscoring the need for individualized rehabilitation and further evaluation of contributing factors.