There exists a growing number of patients with osteoarthritis who are difficult to classify and treat due to their younger age and higher activity level. Many of these athletic patients have sustained meniscal injury, previous meniscectomy, or articular cartilage injury, and may develop osteoarthritic symptoms. Fewer patients present with underlying malalignment or ligamentous instability and increasing arthrosis. Ostoeomies about the knee have been shown to unload isolated medial and lateral compartment osteoarthritis and decrease symptoms in the older adult patient who has been considered too young for total knee replacement. We describe a treatment approach to the younger athlete with isolated unicompartmental osteoarthritis.