There is no consensus on the ideal management of patients with chondral defects of the medial tibial plateau and varus malalignment of the knee. We performed a cohort study to evaluate the outcome of patients affected by these conditions, who underwent arthroscopic implantation of autologous chondrocytes and a medial opening wedge high tibial osteotomy. Eight patients (four men and four women; mean age, 50 years, range: 42 to 58) with chondral defects of the medial tibial plateau in a varus knee underwent arthroscopic implantations of autologous chondrocytes in conjunction with a medial opening wedge osteotomy. At final post-operative follow up of 28 months following the index procedure, the post-operative scores were improved for the IKDC score (four patients abnormal and four patients severely abnormal to four patients normal, three patients nearly normal and one patient abnormal), Lysholm score (65.7 range 49-88 to 94.6 range 89-100), Tegner score (3.7 range 3-5 to 7 range 5-8) and VAS score (7.2 to 2.0). In conclusion, the association of arthroscopic implantation of autologous chondrocytes with a medial opening wedge osteotomy of the proximal tibia is a viable option for the management of chondral defects in varus knees.