Get the latest news and education delivered to your inbox, Receive an email when new articles are posted on, Please provide your email address to receive an email when new articles are posted on. Studies have also reported that patients who underwent a repair of the posterior root in the medial meniscus slowed the progression of arthritic changes compared with those who had a meniscectomy; although, this did not completely prevent the arthritic changes. Arthroscopic treatment is typically required for adequate symptom relief in patients with displaced meniscal flap tears. Br Med Bull 2011;2011:89106. Figure 4. (5a) A longitudinal tear of the posterior horn of the medial meniscus is illustrated. 8 Ruff C, Weingardt J, Russ P, Kilcoyne R. MR imaging patterns of displaced meniscus injuries of the knee. Vincken PW, ter Braak AP, van Erkel AR, et al. Sounds like it will not get better without arthroscopic surgery. Arthroscopic repair of isolated meniscal tears in patients 18 years and younger. Chronic tears may be scarred to the capsule and require release of the meniscocapsular junction to allow anatomic repair. Walking can become difficult. J Fam Pract 2001;50:93844. 1871 LPGA Blvd., Daytona Beach, FL 32117. The medial meniscus is more frequently torn, partly because of this different shape but also because of its attachment to the medial collateral ligament, whereas the lateral is pulled out of the way of compression between femur and tibia by politeus. More often, the patient will complain of joint line pain with a minor traumatic event, such as squatting. There may be some pain. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. These are paraphrased. Bernstein J. From January 2018, it was superseded by AJGP: Australian Journal of General Practice, The Royal Australian College of General Practitioners 2021. A tear of the anterior horn of the lateral meniscus is damage to the front part of one of the two structures that act as shock absorbers between the thigh bone and the lower leg, explains The Steadman Clinic. The goal of meniscal root repair is to restore the joint to a near native function of the meniscus and prevent cartilage degradation associated with nonsurgical treatment or meniscectomy. A meniscectomy requires less time for healing approximately 3 to 6 weeks. what is the treatment? The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. Because other knee injuries can cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis. In sports, a meniscus tear usually happens suddenly. By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. 11 Noyes FR, Barber-Westin SD. 13 Newman AP, Daniels AU, Burks RT. Severe pain and swelling may occur up to 24 hours afterward. During the exam, your doctor will look for signs of tenderness along the joint line. These lie on the inside (medial) and outside (lateral) edges of the top of your tibia (shin bone). Of course, if a displaced meniscal fragment is identified, the tear is by definition unstable. New surgical advances allow surgeons to repair these tears. I have an oblique tear of the posterior horn of my medial meniscus that extends to the undersurface of the cartilage. This makes the medial meniscus less mobile and is one reason why the medial meniscus is more prone to injury.3 In adults, only the periphery of the meniscus remains vascularized. swelling . Tears should be characterized with regard to morphology, size, location, and stability, all of which are important factors that may influence the choice of operative treatment. As stated above, the most common cause of Posterior Horn Medial Meniscus Tear can be trauma to the knee which can be sustained due to a sporting injury, a slip and fall, a blunt trauma to the knee, and in majority of the cases natural degeneration of the meniscus due to the work load of the knee. Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface, Figure 5. Conservative management of the patient with a meniscal tear. The younger population, particularly males with knee instability, is most commonly affected by this type of tear [56]. However, coronal sections may reveal the presence of meniscal extrusion or vertical defects, and sagittal sections may reveal the ghost sign (absence of an identifiable meniscus or increased signal replacing the normal hypointense signal of meniscal tissue). Additionally, the individual will not be able to move the joint due to pain. Posterior medial meniscal root tears are often times degenerative, but these can also occur with multi-ligament knee injuries in the acute setting. MR imaging is reliable in the detection of meniscal tears and identification of meniscal fragmentation and displacement [1, 2, 3, 4].Displaced meniscal fragments are often clinically significant lesions requiring surgical intervention and, therefore, are important to identify. Brain Res Rev 2009;60:187201. There are numerous treatments for meniscus tears, but treatment generally begins conservatively depending on the location, type, and size of the tear. These imaging pearls improve recognition of meniscal root tears (Figure 2). The medial meniscus is an important secondary stabilizer of the knee. 5 Jee WH, McCauley TR, Kim JM, et al. Liodakis E, Hankemeier S, Jagodzinski M, Meller R, Krettek C, Brand J. The described meniscal tears will lead to possible necessary total knee replacement. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Meniscus tears are injuries that occur in the cartilage of the knee. The posterior horn is located on the back half of the meniscus. Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and lubrication and act as shock absorbers for joint preservation. An awkward twist when getting up from a chair may be enough to cause a tear in an aging meniscus. The lateral meniscus is on the outermost side of your knee, so the tear location is outside-front. Meniscal tears are common sports-related injuries in young athletes and can also present as a degenerative condition in older patients. X-rays provide images of dense structures, such as bone. Results: Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90 (P < .05). Repair of such lesions can result in dramatic clinical as well as MR imaging results (17a,17b). Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. A gradient-echo T2*-weighted sagittal image demonstrates a tear within the posterior horn of the medial meniscus (arrow). Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. If you undergo surgery it will likely be followed by physical therapy to optimize knee strength and stability. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. In addition to categorizing meniscal tears based on morphology, care should be taken to describe the exact location of meniscal tears. Research is currently investigating the possibility of implantation of collagen, allogenic and xenogenic cells, embryonic and adult stem cells, or scaffolds derived from polymers, hydrogels, tissues and extracellular matrix,7 and action of biological stimuli (eg. Because of their importance and the clinical impact of meniscal tears, assessment of the menisci has become the most common indication for MR of the knee. So the injury as seen in MRI scan means there is an tear in the medial meniscus towards the posterior side, that is towards the back of joint. They may not even be apparent with an arthroscopic examination. In this case, a portion may break off, leaving frayed edges. The test is positive if symptoms are reproduced on rotation 10. The medial meniscus is C-shaped, while the lateral meniscus is more . In other words, when the majority of the meniscus forms the handle, that requires tear formation near the meniscal periphery, resulting in a vascular site for operative repair. MRI scans show (left) a normal meniscus and (right) a torn meniscus. This means that athletes, especially those who participate in contact sports like football, are at a higher risk of sustaining this injury. All rights reserved. There are numerous types of meniscus tears, including: This type of tear is often a sign of degenerative changes in the meniscus tissue. These tears often occur in association with ACL tears, but even if found in isolation, are highly likely to be clinically relevant, as the displaced meniscal fragment frequently results in knee locking. 12 McGinty JB, Burkhart SS, Jackson RW, et al. Types of meniscus tears:(Left) Bucket handle tear. If mechanical symptoms are present in this subset of patients, a partial or subtotal meniscectomy may improve symptoms; although, these tears are not usually associated with traditional meniscal-based mechanical symptoms. Both of them have 2 causes. Skeletal Radiology 2004; 33:260-264. This is a large horizontal tear of the meniscus. I have a oblique grade 3 tear posterior horn of the medial meniscus. Bove SE, Flatters SJ, Inglis JJ, Mantyh PW. AJR Am J Roentgenol 1998;170:5761. or ? . The McMurray test (shown here) will help your doctor determine if you have a meniscus tear. Characterization of the red zone of knee meniscus: MR imaging and histologic correlation. Aged, worn tissue is more prone to tears. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. A referral to an orthopedic physician should result in guidance it means you need to see in orthopedist and get an opinion as to whether. No bone marrow edema. The treatment may be conservative or sometimes surgery may be required to treat the fracture. AJR 2000; 174:161-164. Tears that lie within or contact the red zone are also more likely to be amenable to meniscal repair. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. A high level of suspicion is required to detect these injuries, and repair is recommended to preserve joint function. In cases where a torn meniscus has locked the knee, walking will be affected. Disclosures: LaPrade reports he is a consultant for and receives royalties from Arthrex, Ossur and Smith & Nephew. Sometimes conservative treatment doesnt work. (Left) Radial tear. The Thessaly test for detection of meniscal tears: validation of a new physical examination technique for primary care medicine. The menisci are two rubbery disks that help cushion the knee joint. AJR 2001; 176:771-776. Meniscal repair surgeries do the best when the meniscal tear extends into the middle 50% of meniscal substance. Always follow your healthcare professional's instructions. Peripheral meniscal tears are among the most common causes of meniscal pathology, particularly occurring in conjunction with anterior cruciate ligament (ACL) injury or deficiency. If an ACL tear is also present, meniscal repairs are more successful if the ACL is also repaired, likely due to the protection afforded by knee stability. Superior and inferior branches of the medial and lateral geniculate arteries supply the peripheral third of the menisci via the perimeniscal capillary plexus.3,4, Meniscal tears occur due to a shear force between the femur and tibia. Explains two kinds of surgery. What to Do If Your Orthopaedic Surgery Is Postponed. On examination, there may be joint effusion, joint line tenderness, and the joint is held in a flexed position.1 in late presentations, there may be significant quadriceps wasting. Clinical outcomes following isolated lateral meniscal allograft transplantation. Trauma to medial collateral ligament usually also involves medial meniscus. We have two menisci in either knee. The skilled interpreter of MR of the knee must do more than simply identify the presence of a meniscal tear. Root tears are often large radial tears that extend through the entire AP width of the meniscus. Only a small peripheral rim of meniscal tissue (arrowhead) is present at the native site of the lateral meniscus. Currently, routine MR images do not reveal signal intensity differences between the red and white zones of the menisci. Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis . All rights reserved. Horizontal cleavage, oblique, and complex meniscal tear patterns have traditionally been poor candidates for meniscal repair. One of the most common knee injuries is a torn meniscus. London;1897. This provides a clear view of the inside of the knee. Nonoperative treatments are often successful in patients with certain types of tear patients who have no loss of joint function, suffer minimal pain or swelling and are willing to reduce their activities temporarily or in the long term. Can a torn meniscus heal by itself? If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. In circumstances where the flap causes catching in the knee, the flap can simply be removed. This is termed the 'red-red zone' (denoting area of vascularity).2,4 repair of the 'red-white zone' (watershed area between vascular and avascular meniscus) is controversial25 with many different surgical techniques.26 tears in the 'white-white zone' (avascular zone) are rarely repaired rather the damaged segment is resected (meniscectomy). Other symptoms of a meniscus tear include: pain in your knee, which can vary in severity - the pain might only be mild, severe, or the pain may come and go. Develop pain gradually along the meniscus and joint line when you put stress on your knees (usually during a repeated activity). Reciprocally, an increased force is also placed on an ACL graft with a deficient medial meniscus. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. The menisci of the knee have several important roles: The medial meniscus is 'C' shaped whereas the lateral is a shorter incomplete circle with closer spaced 'horns'. 2000-2022 The StayWell Company, LLC. The surgery requires a few small incisions and takes about an hour. he is 44 y o tennis player. Pathology - a tear that has developed gradually in the meniscus. I have an oblique tear of the posterior horn and body of the medial meniscus extending to the inferior articular surface. There will also be skin discoloration and visible deformity at the site of the injury. Am J Sports Med 2006;34:91927. Meniscal tear configurations: categorization with MR imaging. It is generally divided into 3 separate portions, the anterior horn, the mid-body and the posterior horn. The ideal candidate for a medial meniscal root repair is an individual younger than 40 years who presents after an acute, traumatic event with a BMI less than 30 and a MRI that shows a medial meniscal root tear without secondary signs of osteoarthrosis or varus malalignment. Each knee has two C-shaped pieces of cartilage known as menisci. What is the posterior horn of the medial meniscus? 2013. Referral to an orthopaedic surgeon is important if the diagnosis is uncertain or there is minimal improvement at clinical review. Although the . If a repair is attempted within meniscal tissue that is questionably vascular or non-vascular, healing enhancement techniques such as the use of fibrin clot and the creation of channels that communicate with the vascular zone may be utilized.10. (10a) A GRE T2*-weighted sagittal image reveals a complex tear of the posterior horn of the medial meniscus, having horizontal (arrows) and longitudinal (arrowhead) components. Meniscus tears, indicated by MRI, are classified in three grades. By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Meniscal pain occurs during torsional, weight bearing knee movements (classically pivoting on the knee while walking) as a sharp stab lasting several seconds, often followed by a dull ache for several hours. Bucket-handle tears are actually a form of longitudinal tear in which subsequent displacement of the inner rim of the tear results in a configuration that resembles the handle of a bucket (11a). Although rarely taught and poorly utilised, recent validation demonstrated a sensitivity of 90%, and specificity of 98% in detecting meniscal injury.10, If clinically suspicious of meniscal injury, a trial of conservative measures may be considered or confirmation with magnetic resonance imaging (MRI). Tears to the medial meniscal root change the biomechanics and kinematics of the knee, which cause early degeneration of the joint. Additionally, the large radial tear dramatically undermines the ability of the meniscus to distribute hoop stress. The operative equipment needs and post-operative rehabilitation process markedly differ between meniscal repair and partial meniscectomy. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Tell your doctor of any recurrent swelling or of your knee repeatedly giving way. The question about meniscus tears and the subsequent MRI in emails we receive are numerous. Weakness, grinding, instability or giving way rarely result from meniscal pathology. Symptomatic treatment with rest, ice, NSAIDs and/or an unloader brace may help alleviate symptoms in some cases. Although the pain improved, the patient could not flex her knee joint deeply. Sometimes, its possible to repair a torn meniscus, especially if you are a young adult. 6 Vande Berg BC, Poilvache P, Duchateau F. Lesions of the menisci of the knee: value of MR imaging criteria for recognition of unstable lesions. Arnoczky SP, Warren RF, Spivak JM. Complex tears like this are likely to be unstable. Physiotherapy at two visits per week for at least 8 weeks is recommended.20 There is little evidence for strapping of meniscal injuries and this is not currently recommended. These injuries have been reported to change joint loading due to failure of the meniscus to convert axial loads into hoop stresses. Know why a new medicine or treatment is prescribed, and how it will help you. How can I tell if I have an oblique fracture? Radiographs may or may not show medial joint space narrowing. If you continue to use this site we will assume that you are happy with it. swelling - this usually happens several hours after you injure your meniscus. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. If you have a follow-up appointment, write down the date, time, and purpose for that visit. At The Orthopedic Clinic, we want you to live your life in full motion. These tendons have poor blood supply and will not heal themselves. The medial meniscus is the portion of the cartilage along the inside of the knee joint (closest to the other knee). Great Britain: Hodder Arnold, 2005. The treatment your doctor recommends will depend on a number of factors, including your age, symptoms, and activity level. An oblique tear (7a,8a) is often referred to as a parrot-beak tear, as the tear shape resembles a parrots beak. Medial meniscal root tears: Fix it or leave it alone Orthopedics Today | Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and. However, it may also occur in older athletes through gradual degeneration. (Right) Degenerative tear. Lists risks and benefits of surgery for meniscus tear. Parrot Beak Tear: MRI Magnetic resonance imaging (MRI) scans. for a 22 year old severe pain. A meniscal cyst may present with signs and symptoms consistent with typical meniscal pathology. Aging is also a risk factor due to general wear and tear of the knees. As the risk of osteoarthritis is increased if meniscal structures are not optimally functional,7 it may also be appropriate to refer all young patients for opinion if symptoms do not rapidly improve. A meniscus tear can lead to knee instability, an inability to move the knee normally, and chronic knee pain. This region of the outer meniscus, sometimes referred to as the red zone, is thought to occupy approximately 15% of the peripheral meniscus.4 Tears that occur within the red zone of the meniscus are more likely to heal than those in the avascular, white zone of the meniscus. An MRI is 70 to 90 percent accurate in identifying whether the meniscus has been torn and how badly. Afterward, you may experience: pain, especially when the area is touched. See your ortho for an evaluation. Printed from Australian Family Physician - https://www.racgp.org.au/afp/2012/april/meniscal-tear The Australian College of General Practitioners www.racgp.org.au, AJGP: Australian Journal of General Practice, https://www.racgp.org.au/afp/2012/april/meniscal-tear, shock absorption and distributing load throughout the joint, providing nutrition for articular cartilage. The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. Dr. Warren Strudwick answered Sports Medicine 32 years experience See your doc: Sounds like it will not get better without arthroscopic surgery. Your doctor may inject a corticosteroid medication into your knee joint to help eliminate pain and swelling. De Carlo M, Armstrong B. J Bone J Surg Am 2006;88:6607. 2023 The Orthopedic Clinic. On MRI, meniscal tears are evident as a linear signal intensity that extends through the meniscal substance to a free edge17 (Figure 4). An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments. In younger patients, this is typically a twisting force on a weightloaded flexed knee. Non-anatomic placement of a PCL reconstruction tibial tunnel is a reported cause of iatrogenic medial meniscal posterior root tears. Makris EA, Hadidi P, Athanasiou KA. It is estimated that only 10% of the injuries involving the tear of posterior horn medial meniscus are repairable. When a meniscus tear occurs, you may hear a popping sound around your knee joint. Nicholas Colyvas, MDClinical ProfessorDepartment of Orthopaedic Surgeryorthosurg.ucsf.edu Feb 1995;11(1):29-36. Two wedge-shaped pieces of fibrocartilage act as shock absorbers between your femur and tibia. Likewise, physical exam findings of an effusion, a positive McMurray test and a positive Apley grind test are not usually present. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. Although an X-ray will not show a meniscus tear, your doctor may order one to look for other causes of knee pain, such as osteoarthritis. Chahla and Geeslin report no relevant financial disclosures. Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. Other established anatomical variants include the transverse meniscal ligaments and the meniscofemoral ligaments, which mimic meniscal tears at their meniscal attachment sites. Arthroscopy 2006;22:77180. Meniscal tears are the most common lesions followed by the meniscal cyst. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. Am J Sports Med 2004;32:67580. Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. How to treat oblique tear of medial meniscus? If your doctor suspects a torn meniscus, he or she will perform aphysicalexam. You will start with exercises to improve your range of motion. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). The best known displaced tear that is amenable to repair is the bucket-handle tear. A comparative study with a short term follow up. The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time. OKeefe R, et al. The meniscus is a C-shaped cartilage disk that is found in the knee. Biologics injections, such as platelet-rich plasma (PRP), are currently being studied and may show promise in the future for the treatment of meniscus tears. All Rights Reserved. Jul 2000;35(3):217-30. They will also consider the type, size, and location of the injury. If this cartilage tears, the result is pain, stiffness, and swelling. Fax Treatment for a meniscus tear will depend on its size, what kind it is, and where it's located within the cartilage. Know the reason for your visit and what you want to happen. AJSM 2003; 31:216-220. The RICE protocol is effective for most sports-related injuries. The content of any advertising or promotional material contained within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. With the foot as close to the hip as possible, the clinician holds the knee joint (with fingers along the joint line) with one hand, and the other hand rotates the tibia internally and externally while extending and flexing the knee. He/she will probably recommend surgery. These are the menisci. Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Over 2 to 3 days, however, the knee will gradually become more stiff and swollen. Symptoms of a meniscus tear. Seldom are they the sign of a problem. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. X-rays and MRIsallow the doctor to evaluate the bone and soft tissue at the knee. Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi The posterior horn it the back portion of the menisci at the end of the curve, where it tapers . If your tear is on the outer one-third of the meniscus, it may heal on its own or be repaired surgically. Harrison BK, Abell BE, Gibson TW. Magnetic resonance imaging is first line for investigating potential meniscal lesions, but should not replace thorough clinical history and examination. Know how you can contact your provider if you have questions. Arthroscopy 2010;26:13689. Missouri: Mosby, 1998. For patients whose procedures have not yet been rescheduled:What to Do If Your Orthopaedic Surgery Is Postponed. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. The lateral meniscus has a symmetrical C-shape, whereas the medial meniscus is more crescentic (3a), as the posterior horn of the medial meniscus is always larger than the anterior horn. Ask if your condition can be treated in other ways. Radiology 2007;242:8593. The most commonly encountered signs are posterior knee pain with deep flexion and joint line tenderness. The menisci act as cushions between your shin bone (tibia) and your thigh bone (femur). Magnetic resonance imaging of the knee menisci. The menisci help to transmit weight from one bone to another and play an important role in knee stability. (11a) A 3D illustration of a bucket handle tear demonstrates that these tears actually are longitudinal in nature (arrows), coursing parallel to the c-shaped fibers of the meniscus. Garrett WE Jr, Swiontkowski MF, Weinstein JN, et al. There are two in each knee, for a total of four. With regard to tear morphology, the classic ideal candidate for meniscal repair is the peripheral longitudinal tear. meniscal tear / avulsion off tibial plateau CIRCUMFERENTIAL FIBERS basicall equivalent to a total meniscetyomy - try to repair these at all cost! 1165 Dunlawton Ave., Suite 102 Port Orange, FL 32127, Port Orange East & Walk-In Clinic The lateral meniscus is on the outside of the knee. AJSM 1999; 27:242-250. 1175 Dunlawton Ave., Suite 101, Port Orange, FL 32127, Palm Coast Arthroscopic partial meniscectomy The goal of this surgery is to remove a small piece of the torn meniscus in order to get the knee functioning normally. In this short surgical video, a degenerative meniscus tear is smoothed down with a motorized shaver during a partial meniscectomy. Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. Meniscal repair using an exogenous fibrin clot. It absorbs shock in your knee and keeps it stable. If the tear cant be repaired, occasionally the meniscus can be surgically trimmed. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist.
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