There is growing debate among orthopedic surgeons regarding optimal alignment strategy in total knee arthroplasty (TKA). While mechanical alignment has long been the dominant philosophy, kinematic alignment has gained popularity for its goal of restoring a patient’s native joint line. This study evaluated how kinematic versus mechanical alignment influences patient goal attainment and postoperative satisfaction among individuals enrolled in the mGAME study. Pre- and postoperative radiographs were manually reviewed to assign Coronal Plane Alignment of the Knee (CPAK) classifications using measurements of lateral distal femoral angle, medial proximal tibial angle, arithmetic hip–knee–ankle angle, and joint line obliquity. Patient-reported outcome measures included KOOS Jr., the Goal Attainment Outcome Measure (GAOM), and CollaboRATE, a validated shared decision-making metric. The primary objective was to compare goal attainment and satisfaction between alignment groups, while a secondary objective assessed whether maintaining the same CPAK classification pre- to post-operatively resulted in improved outcomes. This work aims to clarify whether tailoring alignment to individual anatomy enhances functional recovery and aligns with patient priorities. Findings from this study may help inform surgical planning, optimize satisfaction, and contribute to the ongoing debate regarding personalized alignment strategies in TKA.