The document discusses ligament balancing and alignment in total knee arthroplasty. It defines a balanced knee and describes the goals of ligament balancing as producing symmetrical medial-lateral gaps in extension and flexion. The key principles of ligament balancing are to have 1-3mm of laxity medially in extension and equal medial gaps in flexion/extension, with up to 3 degrees of lateral laxity in extension. Femoral rotation should be aligned to the epicondylar axis rather than adjusted in flexion to balance gaps. Alignment can be achieved via measured resection or gap balancing techniques.