He presented with severe Varus and Posterior instability of left knee following previous ORIF 10 years ago.
Look for the cause resulting in the knee malalignments. Frequently, it starts in the feet as Gravity Drive (abnormal) pronation. If that is the case, determine the cause of the Gravity Drive pronation.
The most common causes are PreClinical Clubfoot Deformity and Primus Metatarsus Supinatus foot deformity.
From the photos you submitted, I suspect and would evaluate this patient for the PreClinical Clubfoot Deformity.
Varus malalignment is obvious and posterior instability is already documented by you.
It would be useful to know the status of collateral ligaments, especially with stress radiographs. Slope of tibial articular surface also needs further assessment with longer radiographs.
A definitive treatment plan can be considered thereafter only. I suspect that would involve staged procedures- a proximal tibial osteotomy along with necessary ligament reconstructions.
it depends on the ligament status that shows it in the MRI. first MRI should be done according to the examination and MRI finding the soft tissues and boney procedure will be done.
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