We report the case of a 31-year-old Olympic fencer, affected by complex degenerative lesions of the knee due to subtotal meniscal loss and patellar overload. The patient underwent a biological knee reconstruction including the treatment of the articular surface combined with lateral meniscal allograft transplantation and patellar realignment. This complex surgical approach significantly improved the knee function and reduced the pain. The athlete was able to get back to official competition 17 months after surgery.