Six randomized controlled trials, including a total of 506 patients, were selected for inclusion into this meta-analysis investigating the effect of patient-specific instrumentation (PSI) of rotational alignment of components following total knee arthroplasty. Sufficient data was available to pool for the incidence of femoral component rotational outliers, defined as deviation from planned rotational alignment exceeding 3 degrees. The result, after addressing a unit-of-analysis error in the primary analysis that was discussed with the authors of the publication, was a non-significant difference in femoral rotational outliers between PSI and conventional instrumentation cohorts. Tibial rotational alignment was reported in only one included study, and demonstrated no significant difference in mean rotational alignment of the tibial component between groups.