Editorial Commentary: Knee Osteotomy Plus Cartilage Restoration Is Not Always Superior to Osteotomy Alone

The treatment of cartilage defects in the setting of varus malalignment remains a challenge. Medial opening-wedge high tibial osteotomy (MOWHTO) is a widely used joint-preserving procedure for medial compartment osteoarthritis and varus malalignment. It is well known that MOWHTO effectively redistributes load across the knee joint, reduces pain, and improves function, with survival rates of up to 90% reported at 10 years postoperatively. When treating malalignment along with cartilage damage, combined procedures, such as MOWHTO with cartilage restoration or meniscal transplantation, may be performed. Although cartilage microfracture may improve early cartilage appearance on arthroscopy, it does not necessarily translate to superior long-term clinical outcomes. Furthermore, the conjunction fallacy-the mistaken belief that combining procedures must lead to better outcomes-may contribute to overtreatment, increased surgical morbidity, and greater costs.