Excellent results of total knee arthroplasty have outweighed high tibial osteotomy applications in the treatment of osteoarthritis of the knee joint, but there is a growing interest in osteotomies as an adjunct in the treatment of full-thickness chondral and osteochondral lesions of the knee. Abnormal biomechanics in both tibiofemoral and patellofemoral articulations resulting from instability and malalignment should be corrected and osteotomy should be regarded as the first step in the treatment of these lesions. A simultaneous or staged osteotomy may contribute to the success of current techniques used for cartilage and osteochondral repair. Clinical, radiographic, and experimental studies have shown beneficial effects of osteotomies on cartilage regeneration. The aim of the osteotomy is simple: cartilage needs proper biomechanical environment for healing.