{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T16:06:26Z","timestamp":1789142786993,"version":"build-2803163510"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"DOI":"10.1007\/s00402-026-06448-4","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:07:38Z","timestamp":1789139258000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Are kneeling stress radiography and the posterior sag sign associated with subjective flexion instability after posterior-stabilized total knee arthroplasty?"],"prefix":"10.1007","volume":"146","author":[{"given":"Mehmet","family":"A\u015fk\u0131n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6m\u00fcr","family":"\u00c7a\u011flar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet Mazhar","family":"Tokg\u00f6zo\u011flu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00fclent","family":"Atilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"6448_CR1","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1302\/0301-620X.96B12.34538","volume":"96\u2013B","author":"MP Abdel","year":"2014","unstructured":"Abdel MP et al (2014) Stepwise surgical correction of instability in flexion after total knee replacement. Bone Joint J 96\u2013B:1644\u20131648. https:\/\/doi.org\/10.1302\/0301-620X.96B12.34538","journal-title":"Bone Joint J"},{"key":"6448_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13018-021-02267-w","volume":"16","author":"T Al-Jabri","year":"2021","unstructured":"Al-Jabri T et al (2021) Management of instability after primary total knee arthroplasty: an evidence-based review. J Orthop Surg Res 16:1\u201310. https:\/\/doi.org\/10.1186\/s13018-021-02267-w","journal-title":"J Orthop Surg Res"},{"key":"6448_CR3","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s11999-009-1119-9","volume":"468","author":"RB Bourne","year":"2010","unstructured":"Bourne RB et al (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57\u201363. https:\/\/doi.org\/10.1007\/s11999-009-1119-9","journal-title":"Clin Orthop Relat Res"},{"key":"6448_CR4","doi-asserted-by":"publisher","first-page":"1494","DOI":"10.1016\/j.arth.2023.01.048","volume":"38","author":"MJ DeFrance","year":"2023","unstructured":"DeFrance MJ, Scuderi GR (2023) Are 20% of patients actually dissatisfied following total knee arthroplasty? A systematic review of the literature. J Arthroplasty 38:1494\u20131500. https:\/\/doi.org\/10.1016\/j.arth.2023.01.048","journal-title":"J Arthroplasty"},{"key":"6448_CR5","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1097\/00003086-199907000-00024","volume":"364","author":"D Dejour","year":"1999","unstructured":"Dejour D et al (1999) Laxity in posterior cruciate sparing and posterior stabilized total knee prostheses. Clin Orthop Relat Res 364:182\u2013193. https:\/\/doi.org\/10.1097\/00003086-199907000-00024","journal-title":"Clin Orthop Relat Res"},{"key":"6448_CR6","doi-asserted-by":"publisher","first-page":"3854","DOI":"10.1016\/j.arth.2017.07.021","volume":"32","author":"R Gunaratne","year":"2017","unstructured":"Gunaratne R et al (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32:3854\u20133860. https:\/\/doi.org\/10.1016\/j.arth.2017.07.021","journal-title":"J Arthroplasty"},{"key":"6448_CR7","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1055\/s-0041-1740992","volume":"36","author":"CM Howie","year":"2023","unstructured":"Howie CM et al (2023) Radiographic findings in flexion instability after total knee arthroplasty. J Knee Surg 36:411\u2013416. https:\/\/doi.org\/10.1055\/s-0041-1740992","journal-title":"J Knee Surg"},{"key":"6448_CR8","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1177\/0363546508314423","volume":"36","author":"T Jackman","year":"2008","unstructured":"Jackman T et al (2008) Intraobserver and interobserver reliability of the kneeling technique of stress radiography for the evaluation of posterior knee laxity. Am J Sports Med 36:1571\u20131576. https:\/\/doi.org\/10.1177\/0363546508314423","journal-title":"Am J Sports Med"},{"key":"6448_CR9","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1016\/j.arth.2014.12.013","volume":"30","author":"A Kannan","year":"2015","unstructured":"Kannan A et al (2015) Revision TKA for flexion instability improves patient reported outcomes. J Arthroplasty 30:818\u2013821. https:\/\/doi.org\/10.1016\/j.arth.2014.12.013","journal-title":"J Arthroplasty"},{"key":"6448_CR10","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1016\/j.arth.2020.08.038","volume":"36","author":"YH Kim","year":"2021","unstructured":"Kim YH et al (2021) The 22 to 25-year survival of cemented and cementless total knee arthroplasty in young patients. J Arthroplasty 36:610\u2013615. https:\/\/doi.org\/10.1016\/j.arth.2020.08.038","journal-title":"J Arthroplasty"},{"key":"6448_CR11","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/S0929-6646(08)60134-9","volume":"107","author":"HT Lin","year":"2008","unstructured":"Lin HT et al (2008) Comparison of EMG activity between maximal manual muscle testing and cybex maximal isometric testing of the quadriceps femoris. J Formos Med Assoc 107:175\u2013180. https:\/\/doi.org\/10.1016\/S0929-6646(08)60134-9","journal-title":"J Formos Med Assoc"},{"key":"6448_CR12","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1007\/s00167-004-0521-7","volume":"13","author":"S Louisia","year":"2005","unstructured":"Louisia S et al (2005) Assessment of posterior stability in total knee replacement by stress radiographs. Knee Surg Sports Traumatol Arthrosc 13:217\u2013222. https:\/\/doi.org\/10.1007\/s00167-004-0521-7","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"6448_CR13","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.1016\/j.arth.2017.01.015","volume":"32","author":"K Matsumoto","year":"2017","unstructured":"Matsumoto K et al (2017) Postoperative anteroposterior laxity influences subjective outcome after total knee arthroplasty. J Arthroplasty 32:1845\u20131849. https:\/\/doi.org\/10.1016\/j.arth.2017.01.015","journal-title":"J Arthroplasty"},{"key":"6448_CR15","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1016\/j.arth.2022.02.050","volume":"37","author":"SC Mears","year":"2022","unstructured":"Mears SC et al (2022) Inter-rater reliability of clinical testing for laxity after knee arthroplasty. J Arthroplasty 37:1296\u20131301. https:\/\/doi.org\/10.1016\/j.arth.2022.02.050","journal-title":"J Arthroplasty"},{"key":"6448_CR16","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1007\/s00167-021-06501-4","volume":"30","author":"LB Moser","year":"2022","unstructured":"Moser LB et al (2022) Stress radiographs in the posterior drawer position at 90 degrees flexion should be used for the evaluation of the PCL in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30:584\u2013591. https:\/\/doi.org\/10.1007\/s00167-021-06501-4","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"6448_CR17","doi-asserted-by":"publisher","first-page":"3581","DOI":"10.1007\/s00167-020-06373-4","volume":"29","author":"M Murer","year":"2021","unstructured":"Murer M et al (2021) Threshold values for stress radiographs in unstable knees after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 29:3581\u20133587. https:\/\/doi.org\/10.1007\/s00167-020-06373-4","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"6448_CR18","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/00003086-199811000-00008","volume":"356","author":"M Pagnano","year":"1998","unstructured":"Pagnano M et al (1998) Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res 356:39\u201346. https:\/\/doi.org\/10.1097\/00003086-199811000-00008","journal-title":"Clin Orthop Relat Res"},{"key":"6448_CR19","first-page":"295","volume":"57","author":"S Parratte","year":"2008","unstructured":"Parratte S, Pagnano MW (2008) Instability after total knee arthroplasty. Instr Course Lect 57:295\u2013304","journal-title":"Instr Course Lect"},{"key":"6448_CR20","doi-asserted-by":"publisher","first-page":"452","DOI":"10.22038\/abjs.2020.48036.2380","volume":"9","author":"EC Rodriguez-Merchan","year":"2021","unstructured":"Rodriguez-Merchan EC (2021) Patient satisfaction following primary total knee arthroplasty: contributing factors. Arch Bone Jt Surg 9:452\u2013459. https:\/\/doi.org\/10.22038\/abjs.2020.48036.2380","journal-title":"Arch Bone Jt Surg"},{"key":"6448_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13018-023-03573-x","volume":"18","author":"SP Ryan","year":"2023","unstructured":"Ryan SP et al (2023) Evaluation of anterior translation in total knee arthroplasty utilising stress radiographs. J Orthop Surg Res 18:1\u20135. https:\/\/doi.org\/10.1186\/s13018-023-03573-x","journal-title":"J Orthop Surg Res"},{"key":"6448_CR22","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1097\/01.blo.0000185448.32907.e9","volume":"440","author":"JH Schwab","year":"2005","unstructured":"Schwab JH et al (2005) Flexion instability without dislocation after posterior stabilized total knees. Clin Orthop Relat Res 440:96\u2013100. https:\/\/doi.org\/10.1097\/01.blo.0000185448.32907.e9","journal-title":"Clin Orthop Relat Res"},{"key":"6448_CR23","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s00264-006-0128-z","volume":"31","author":"JK Seon","year":"2007","unstructured":"Seon JK et al (2007) In vivo stability of total knee arthroplasty using a navigation system. Int Orthop 31:45\u201348. https:\/\/doi.org\/10.1007\/s00264-006-0128-z","journal-title":"Int Orthop"},{"key":"6448_CR24","doi-asserted-by":"publisher","first-page":"2696","DOI":"10.1007\/s00167-012-2325-x","volume":"21","author":"X Shi","year":"2013","unstructured":"Shi X et al (2013) The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2696\u20132703. https:\/\/doi.org\/10.1007\/s00167-012-2325-x","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"6448_CR25","doi-asserted-by":"publisher","first-page":"642","DOI":"10.5435\/JAAOS-D-18-00347","volume":"27","author":"JB Stambough","year":"2019","unstructured":"Stambough JB et al (2019) Flexion instability after total knee arthroplasty. J Am Acad Orthop Surg 27:642\u2013651. https:\/\/doi.org\/10.5435\/JAAOS-D-18-00347","journal-title":"J Am Acad Orthop Surg"},{"key":"6448_CR26","first-page":"515","volume":"61","author":"KG Vince","year":"2012","unstructured":"Vince KG (2012) Diagnosis and management of patients with instability of the knee. Instr Course Lect 61:515\u2013524","journal-title":"Instr Course Lect"},{"key":"6448_CR27","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/s0883-5403(98)90014-4","volume":"13","author":"GL Waslewski","year":"1998","unstructured":"Waslewski GL et al (1998) Early, incapacitating instability of posterior cruciate ligament-retaining total knee arthroplasty. J Arthroplasty 13:429\u2013434. https:\/\/doi.org\/10.1016\/s0883-5403(98)90014-4","journal-title":"J Arthroplasty"},{"key":"6448_CR28","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1007\/s00402-019-03222-5","volume":"139","author":"N Wuertele","year":"2019","unstructured":"Wuertele N et al (2019) Posterior condylar resections in total knee arthroplasty: current standard instruments do not restore femoral condylar anatomy. Arch Orthop Trauma Surg 139:1531\u20131537. https:\/\/doi.org\/10.1007\/s00402-019-03222-5","journal-title":"Arch Orthop Trauma Surg"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06448-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-026-06448-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06448-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:07:40Z","timestamp":1789139260000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-026-06448-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6448"],"URL":"https:\/\/doi.org\/10.1007\/s00402-026-06448-4","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]},"assertion":[{"value":"20 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Decarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee (Hacettepe University Non-Interventional Clinical Research Ethics Board, Decision No: 2024\/10-39, Registration No: SBA 24\/088) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Decarations"}}],"article-number":"333"}}