Nakamura S, et al. - Axial CT scans and axial radiograph were taken in 115 consecutive knees following TKA by the researchers to investigate the impact of the tibial tubercle-trochlear groove (TT-TG) distance and component rotation on patellar tilt and patellar shift following TKA. TT-TG distance had an important relation with patellar tilt in extension, patellar tilt in flexion, and patellar shift. The tibial component rotation had a significant association with patellar tilt in flexion and patellar shift. The femoral component rotation had no notable relationships. The tibial component rotation had a significant association with TT-TG distance whereas femoral component rotation had no association. Therefore, TT-TG distance had a significant relationship with the patellar tilt and patellar shift. Surgeons are required to understand the factors influencing TT-TG distance and to pay heed to avoid excessive TT-TG distance following TKA.