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Medial opening-wedge high tibial osteotomy has become increasingly popular for treating isolated, medial compartment arthrosis in younger, more active patients. Relative indications include age younger than 55 to 60 years, normal weight, preserved range of motion, and isolated medial compartment osteoarthritis or overload. Several surgical techniques exist for stabilization of the osteotomy with similar outcomes. Complication rates after medial opening-wedge high tibial osteotomy vary from 29% to 37%, with highest risk of nonunion, fracture, stiffness, and loss of correction. Good long-term outcomes can be achieved, with 5- and 10-year survivorship rates ranging from 75% to 98.7% and 51% to 97.6%, respectively.

Older athletes consist of a relatively healthier population with a high desire for return to sport despite knee injury. A meniscal tear is a common injury that has lasting impacts on joint function and activity level. Lower extremity loading from sporting activity in conjunction with degenerative meniscal changes increases the risk of meniscal tear in older athletes. Optimal treatment of degenerative meniscal tears is often debated with varying studies reporting the benefits of strictly nonoperative treatment or the value of surgery. Postoperative rehabilitation is crucial to enhance the possibility of return to sport.

In 1948, Fairbank described the radiographic changes that develop after meniscecomy, suggesting the protective effect of the meniscus. Early biomechanical studies ave further defined the importance of the meniscus in normal knee joint function. hese studies found a 50% to 70% reduction in femoral condyle contact, a 100% ncrease in contact stress with removal of the medial meniscus, a 40% to 50% ecrease in contact area, and increase in contact stress to 200% to 300% with emoval of the lateral meniscus. Since then, it has become a well-accepted notion that the menisci play a critical role in load transmission, shock absorption, and secondary stabilization of the knee. Acceptance of the crucial role of the meniscus in knee kinematics coupled with improved understanding of meniscal healing, anatomy, microstructure, and biochemistry has led to the concept that, whenever feasible, the meniscus should be preserved rather than resected. As the preferred method of treatment of meniscal injuries has swung from resection to preservation over the last several decades, the techniques used to repair meniscal tears has also evolved. Current techniques typically use an arthroscope and favor smaller incisions to decrease the amount of surgical trauma. Techniques are commonly described as outside-in, inside-out, and all-inside, with each technique having it own advantages and disadvantages. The outside-in technique is named for the direction that the suture is first passed into the knee joint. As described in further detail in the technique section of this report, several subtle technique variations exist when performing an outside-in meniscal repair, but all techniques use a spinal needle to enter the joint under direct visualization, minimizing the risk of injury to both articular cartilage and extracapsular

The number of people participating in sports continues to increase. The relationship between sports participation, joint injury, and subsequent osteoarthritis is complex. A history of joint injury and participation in high joint loading sports increases the risk of subsequent osteoarthritis changes in affected joints. The impact of osteoarthritis on sports careers depends on multiple factors including the joint involved, the location within that joint, and the physical demands of the chosen sport.