The Role of Alignment Correction With and Without Chondral Repair

The interplay between the biological environment and the mechanical environment is important to consider when managing chondral pathology of the knee. Unaddressed malalignment is a risk factor for failure of an isolated chondral restorative procedure, and the underlying chondral status is an important factor in the functional outcome and survivorship of a realignment osteotomy. Intuitively, there may be a role for a combined approach in selected cases; however, the specific indications continue to be refined. In this chapter, we will review the association of alignment, load distribution and cartilage health and describe our preferred surgical approach to realignment. We will also review the current evidence on outcomes of alignment correction with and without chondral repair and finally provide a treatment algorithm for patients presenting with early unicompartmental knee chondral pathology with concurrent malalignment.