The classic total knee arthroplasty (TKA) mechanical alignment (MA) surgical procedure aspires to consistently establish neutral limb alignment and a coronal joint line perpendicular to the mechanical axis between hip and ankle centers. Soft tissue releases are required to compensate for the non-anatomical joint line that is established. Patient specific surgical procedures restore the knee joint articulating surfaces and joint line to the individual’s previous healthy condition, not necessarily a global normal that is the goal of classic TKA surgery. A patient specific restoration holds the promise of eliminating adjustments to the soft tissue envelope and restoring joint motion that is ‘normal’ for that individual, thereby increasing patient satisfaction.