Background: Reduced medial joint space  is a critical biomechanical derangement which  accelerates cartilage degeneration and contributes to progressive osteoarthritis. Early and precise management can restore knee kinematics and delay the need for total knee arthroplasty (TKA).

Objective: To evaluate the spectrum of current treatment modalities for reduced medial joint line including meniscus root repair, high tibial osteotomy (HTO), and unicondylar knee replacement (UKR), and to identify optimal patient selection criteria and long term outcomes

 Methods: In depth review of recent literature and clinical experience was performed. Indications, surgical techniques, postoperative rehabilitation protocols, and outcome measures of meniscus root repair, HTO, and UKR were analyzed. Patient were selected on basis of  degree of cartilage damage, varus deformity, age, activity level, and associated ligamentous or chondral injuries.

Results: Meniscus root repair is effective in restoring hoop stresses and preserving native joint kinematics in young patients with minimal cartilage degeneration. HTO is the preferred option in active, middle-aged patients with varus malalignment,as it redistributes load-bearing forces. UKR provides a reliable solution for older patients with isolated medial compartment disease, allowing rapid functional recovery with minimal bone resection. Correct patient selection based on age, cartilage status, and alignment is paramount for durable results.

Conclusion: A tailored approach combining meniscus root repair, HTO, or UKR based on patient-specific pathology can effectively manage reduced medial joint space, restore biomechanics, can significantly improve functional outcomes and delay TKA. Future prospective comparative   studies and biologic adjuncts may further improve long-term outcomes.

Keywords: Medial joint line, meniscus root repair, high tibial osteotomy, unicondylar knee replacement, knee biomechanics.

Girish Autade is a distinguished Orthopaedic Surgeon with over 35 years of practice in Nashik, India. He completed his MBBS and Diploma in Orthopaedics from Medical College, Aurangabad, followed by an M.Ch. in Orthopaedics. During his residency at Bombay Hospital, Mumbai, in 1989, he gained early exposure to arthroscopy and arthroplasty, which later became his main areas of expertise. From 1990 to 1999, he served in public health hospitals, where he handled a wide range of trauma and spine surgery cases, gaining vast clinical experience. In 2007, he founded Ashwini Multispeciality Hospital, a tertiary care center providing advanced treatment in orthopaedic trauma, arthroscopy, arthroplasty, neurosurgery, and plastic surgery, and also recognized as a fellowship training center for arthroscopy. Under the National Rural Health Mission (NRHM), he contributed to community health by screening and supporting corrective surgeries for children whose education was hindered by medical issues. Dr. Autade has presented several papers on arthroscopy, arthroplasty, trauma, and paediatric orthopaedics at national and international conferences, making valuable contributions to both clinical practice and academic exchange.