Panni AS, et al. - This study was designed to assess the impact of tibial rotational alignment after total knee arthroplasty (TKA) on clinical outcomes. Researchers also evaluated the eventual cut-off values for tibial TKA rotation leading to poor outcomes. In this work, excessive internal rotation of the tibial TKA component was recognized, rather confirmed to be, a significant risk factor for pain and inferior functional outcomes after TKA (> 10° of internal rotation demonstrated the common value), since external rotation did not influence the outcomes. However, the available literature data did not suggest a universal precise cut-off value and there remains a debate about CT rotation assessment and surgical intra-operative landmarks.