The Ilizarov technique and other circular fixators remain the gold standard for the management of tibial length discrepancies. A key advantage of circular fixators is their ability to easily correct existing deformities or those that may develop during lengthening. This review aims to summarize the indications, preoperative planning, surgical techniques, postoperative care, and complications in adult and pediatric patients. Careful patient selection, meticulous planning, and multidisciplinary care can yield satisfactory results, although complication rates remain significant.