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This thesis addresses knee joint preservation through a hierarchical strategy: first correcting malalignment, then restoring or replacing the meniscus, and finally targeted cartilage repair. The rationale is that mechanical axis correction creates a favorable biomechanical environment essential for successful biological interventions. Clinical studies demonstrate that osteotomies reduce load in the affected compartment, alleviate pain, and slow osteoarthritis progression. Meniscal volume and function preservation are examined via meniscal repair and allograft transplantation, including biologically enhanced approaches using cellular techniques. Experimental models using robotic loading and photochemical bonding provide insights into meniscal stress and healing mechanisms. Cartilage repair strategies investigated include fixation of chondral-only fragments, treatment of osteochondritis dissecans, and the role of defect size in repair decision-making. The findings show that integrated strategies combining mechanical optimization and biological repair result in improved clinical outcomes and may delay the need for arthroplasty. This thesis proposes an evidence-based framework for patient-specific knee preservation, uniting biomechanical correction with advanced restorative techniques to maximize native joint longevity.