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These findings informed the SGDM intervention and the randomized controlled trial evaluation protocol.Background Mid-flexion instability after total knee arthroplasty (TKA) is a clinical entity that is not well studied and one that has been associated with patient dissatisfaction and inferior outcomes. We sought to provide a comprehensive review of risk factors associated with mid-flexion instability. Methods A comprehensive literature search of PUBMED, EMBASE, Google Scholar, and Cochrane Library was performed using