The two most frequent techniques used to implant a total knee replacement (TKR) are measured resection and gap balancing. Both methods have been around for a while and are currently in widespread usage, and both have shown to be effective in the real world. Plus, new technologies have evolved in the recent past to help surgeons achieve soft tissue balance and limb alignment.Proper alignment of a knee replacement is crucial to its effective functioning. It has to be in the right axial and rotational planes for this to work. Patellofemoral instability and early wear can be caused by improper alignment, as can loosening of the prosthesis. Altering the prosthesis's orientation might potentially affect the tension of the surrounding soft tissues. We have extensively reviewed 50 studies (Level 1- Level 4) published in many prestigious journals by searching through platforms like PUBMED, MEDLINE and EMBASE databases. In this research, we have attempted to document the relationship between alignment and the equilibrium of soft tissues and to summarize the present state of our understanding of this connection.