The knee is a complex joint and where possible it is important that one tries to preserve it. In this regard, it is prudent to repair meniscus tears and treat articular cartilage lesions where appropriate and consider all non-operative options. Knee replacement surgery is generally a very successful operation in selected patients but once the joint is excised, this is irreversible. It may not always be the best option for some patients, for example young patients, very active older patients and those who undertake physically demanding occupations or pursuits. Joint restoration and preservation procedures may help put off joint replacement surgery.