Objective To review the advance in the researchand clinical application of the tibial rotational alignment technique in the total knee arthroplasty in China and abroad. Methods The recent literature concerned with the tibial rotational alignment technique in the totalknee arthroplasty was extensively reviewed and briefly summarized. Results According to the literature reviewed, the traditional tibial rotational references for the total knee arthroplasty were affected by many factors, so that the references were not accurate enough. There have been no unified references.ConclusionChoosing the range from the medial border of the tibial tubercle to the medial 1/3 of the tibial tubercle, decided by the degrees of the varus deformities and the valgus deformities, to determine the rotaional alignment of the tibial component will create an optimal tibiofemoral rotational alignment.