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The surgical management of Knee Osteoarthritis (KOA), so far, mainly revolved around arthroscopic procedures, arthroplasty (total: TKA and unicompartmental: UKA) or high tibial osteotomy (HTO). Recently, another minimally invasive surgical treatment of proximal fibular osteotomy (PFO) has been proposed for the management of KOA. The PFO has been found to be useful in the management of pain in KOA. The success of PFO depends on the correct location of the osteotomy and the right surgical technique. However, the experience of this procedure is minimal. Still, many questions need to be answered about the PFO viz. selection of best candidates and likely duration of pain relief. More multicentric, comparative and prospective studies are needed on a more substantial number of patients, the overlong follow-up to confirm its validity and recommendation for routine use for KOA., (© BY THE ARCHIVES OF BONE AND JOINT SURGERY.)