With regards to the knee, the term "alignment" in orthopedics refers to the relative positions of the bones as they meet at the joints. Just as with a car, which has a wheel out of alignment that leads to wear on one side of a tire, so to, in a human, being “out of alignment” can potentially cause problems. This is usually referred to as malalignment or “excessive positioning” and can involve both the long bones and/ or the kneecap. With malalignment, the forces through the joint may be altered to the point that can result in joint pain and/or degenerative joint disease changes over time. When considering joint and/ or cartilage restoration, an important step is to restore proper alignment and thus improve loads (forces) through the knee. Said another way, if you have a car wheel out of alignment that causes tire (cartilage) wear, it does not make sense to simply replace the tire (cartilage) without correcting the alignment to stop the abnormal wear.