100 patients were randomly assigned to undergo total knee arthroplasty with either anterior referencing or posterior referencing techniques. This study aimed to compare the clinical (KSS, ROM, quadriceps muscle strength, and SF-12) and surgical outcomes (duration of surgery, estimated blood loss, length of incision, and length of stay) of both techniques at 2 years post-operative. Findings suggested that there were no statistically significant differences in any of the assessed clinical or surgical outcomes between anterior and posterior referencing techniques. Both anterior and posterior referencing techniques were effective and can be successfully used during minimally invasive total knee arthroplasty.