Cartilage lesions are seen frequently and particularly at weight bearing lower extremity joints. The healing potential of cartilage tissue is so limited because of its unique nature. Because of this while planning the treatment of cartilage lesions at weight bearing joints, malalignment and deformities which may cause abnormal loads on cartilage lesion sites should be investigated. Because of its incongruous geometrical structure and common occurence of malalignment, incidence of cartilage lesions is high in knee joint of lower extremity. In patients who have concominant medial compartment cartilage lesion and varus alignment proximal tibial valgus osteotomy can be performed in addition to cartilage lesion treatment. Conversely in patients who have lateral compartment cartilage lesion and valgus alignment distal femoral varus osteotomy procedure can be added to treatment plan. For the hip joint cartilage lesions to decrease the contact on a particular area and transfer the weight on a healthy surface acetabuler and proximal femoral osteotomies can be performed. The malalignment and deformities which cause abnormal loads on joints should be taken into consideration for the treatment of cartilage lesions.