Chronic valgus instability with concomitant valgus malalignment is a challenging diagnosis that cannot be successfully treated with ligament surgery alone. Hyperextension valgus thrust may be a symptom of this configuration, expressing the need for thorough diagnosis and treatment. The present article will help to understand pathoanatomy and mechanisms of chronic valgus instability in combination with malalignment and provide a description of treatment techniques, in particular medial closing wedge distal femoral varus osteotomy (MCWDFVO) and lateral opening wedge high tibial osteotomy (LOWHTO), and their indications to deal with both issues simultaneously.