High tibial osteotomy (HTO) is a joint-preserving surgery to correct varus malalignment in conditions like medial tibiofemoral osteoarthritis, ligament insufficiencies, and posterolateral corner deficiencies. It is often combined with medial meniscus root repair to alleviate stress and promote healing. HTO techniques include medial opening wedge osteotomy, which uses bone grafts and suits patients with ligament laxity or patella alta, and lateral closing wedge osteotomy, which provides stability and allows faster rehabilitation without grafting. Additional techniques like focal dome osteotomy address specific deformities. HTO is commonly paired with cartilage repair (e.g., chondrocyte implantation) and meniscus procedures. Rehabilitation programs must avoid active hamstring exercises post-meniscus repair to prevent complications.