America's fourth largest city is a great place to live, work and play. Stretch your legs before and after exercise. Sometimes, surgeons make this decision for additional protection during the operation, when they see that the tendon shows more damage than expected, or that the tear is more extensive. Repairing and strengthening the cartilage and ligaments is a preventative measure to restabilize the knee. Part of Consult with a trainer or physical therapist to help you evaluate how soon to return to your favorite activity, and how to work gradually back to full strength. from the American Academy of Orthopaedic Surgeons, Knee buckles and can no longer support your weight, Pain in the front of the knee that increases with activity, Creaking or cracking sounds during movement. If re-dislocation occurs then reconstruction of the medial patellofemoral ligament (MPFL) is the recommended surgical option. [2], When there is too much tension on the patella, the ligaments will weaken and be susceptible to tearing ligaments or tendons due to shear force or torsion force, which then displaces the kneecap from its origination. In most cases, the kneecap shifts to the outside of the leg, but it can also move towards the inside. Although patellar tendonitis is known as ''jumpers knee,'' it can affect anyone. They connect the quadriceps muscle to the shin bone and, less precisely, are sometimes called patellar ligaments. But does it work and what are, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. [3], A patellar dislocation typically occurs when the knee is straight and the lower leg is bent outwards when twisting. 2005-2022 Healthline Media a Red Ventures Company. This will allow you to move more freely with a greater range of motion. An example of a severe case of a tracking disorder is a dislocation. A stabilizing brace may also be prescribed. Proximal Tib-Fib Dislocation Knee Overuse injuries drill 2 trans-patellar bony tunnels and pass the sutures through tunnels and tie over the top of patella. Surgery to repair the torn tendon is relatively straightforward in Patellar Dislocation and Instability in Children (Unstable Kneecap). Get at least one second opinion before proceeding with surgery. If youre a runner or athlete, you probably already know that your sport can put a lot of stress on your knees. They may observe you walk, squat, rise from a seated position, and sit down. How long you need therapy and which exercises your treatment team prescribes will be based on the type of tear you have, your surgical repair, your medical condition, and your needs. While patellar tendon surgery isn't painful in and of itself due to anesthesia, the recovery itself may prove challenging. All material on this website is protected by copyright. This sometimes involves using donated tissue (allograft). [citation needed], People who have larger Q angles tend to be more prone to having knee injuries such as dislocations, due to the central line of pull found in the quadriceps muscles that run from the anterior superior iliac spine to the center of the patella. Although it is more common in runners, it is often referred to as "jumper's knee.". When a person has a dislocated jaw it is difficult to open and close the mouth. Patellar instability is a spectrum of conditions ranging from intermittent subluxations to dislocation. The patella is also often felt and seen out of place. Knee problems: Patellofemoral disorders. Two types of treatment options are typically available: Surgery may impede normal growth of structures in the knee, so doctors generally do not recommend knee operations for young people who are still growing. Finding the right physician is one of the most important steps in managing your healthcare. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. Episode 181: Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up Your surgeon may need to add tissue graft to lengthen the tendon. You may have to stay home for a week or longer after surgery. Diagnosis of patellar tracking disorder can be difficult, because its part of a broad range of conditions that can affect the knee, with fairly similar symptoms. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). [18] External supports, such as knee braces and athletic tape, work by providing movement in only the desired planes and help hinder movements that can cause abnormal movement and injuries. Chronic patellar instability, if not treated, may lead to severe arthritis and chondromalacia patellae. Resistance exercises can build up tendons, but to help regain strength, stability, and range of motion, you need to do exercises for the quadriceps muscles. Have an edit or suggestion for this page. Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Be sure to talk with your doctor and specialist about whats best for you. Generally, patellar tracking disorder comes from high stress on the knee, especially the twisting motions that occur in many sports. Race is a significant factor for this injury, where Hispanics, African-Americans and Caucasians had slightly higher rates of patellar dislocation due to the types of athletic activity involved in: basketball (18.2%), soccer (6.9%), and football (6.9%), according to Brian Waterman. That certainly is the case with your knee. Many people report stiffness in the affected leg, but most regain range of motion nearly equal to that in the uninjured leg. Surgery is recommended by some experts in order to repair the medial structures early, while others recommend treating it non operatively with physical therapy. To provide extra protection to the repair, some surgeons use a wire, sutures, or cables to help hold the kneecap in position while the tendon heals. [1] Generalized patellar instability is thought to represent up to 3% of clinical presentations involving the knee. Knee Surgeries Could Soon Be More Successful Thanks to New Technique, New Medical Device May Eliminate Need for Some Knee Replacement Surgery. It typically must be put back in place, which is called a reduction. [2], Patellar dislocation occurs in sports that involve rotating the knee. An MRI creates better images of soft tissues, like the patellar tendon, than an X-ray. By Jonathan Cluett, MD In borderline cases of subluxation, the following measurements can be helpful: The patella is a floating sesamoid bone held in place by the quadriceps muscle tendon and patellar tendon ligament. Patellar tendon tears are more common in biological males, but research suggests that risk arises from the activities themselves. Tendons are strong cords of fibrous tissue that attach muscles to bones. Even with these steps, there is a minimum of three months until the return of normal daily activities, and four to six months until sports should be resumed. Females are more susceptible to patellar dislocation. The tendons of the knee. [8] The pathophysiology of the kneecap is complex, and deals with the osseous soft tissue or abnormalities within the patellofemoral groove. Patellar instability, by definition, is a condition where the patella bone pathologically disarticulates out from the patellofemoral joint, either subluxation or complete dislocation. Reproduced and adapted from J Bernstein, ed: Musculoskeletal Medicine. The knee pain could be due to other things, even something as simple as your footwear. At least one manufacturer claims that the tape lessens pain and improves healing by creating a space between the skin and the tissue below to allow for improved blood and lymph flow. Verywell Health's content is for informational and educational purposes only. This will keep your knee straight to help it heal. Last medically reviewed on February 14, 2019. [1] This is then followed by physical therapy. It can be worn during day-to-day activities, as well as non-contact sports. Several ligaments and tendons hold the patella in place and allow it to move up and down the patellofemoral groove when the leg bends. A large tear of the patellar tendon is a disabling injury. If requested before 2 p.m. you will receive a response today. This is similar to a rope stretched so far that some of the fibers are frayed, but the rope is still in one piece. Patellar tracking disorder (or patellar maltracking) describes movement of your kneecap that isnt aligned, like your kneecap moving sideways. All rights reserved. Whether you walk a lot or are an athlete, holding back to avoid over-exertion after an injury may be the hardest advice to follow, but its also one thing you can do to get you back to your activity the fastest. Each issue also contains at least one review article about an important clinical problem. Patellar tendon tears are usually obvious on clinical examination. Content is reviewed before publication and upon substantial updates. (2015). All material on this website is protected by copyright. In such cases physiotherapy or surgery may be offered to increase the support around the shoulder and to reduce the chance of further dislocations. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an Orthopaedist. This most often involves multiple factors, from acute trauma, chronic ligamentous laxity, bony malalignment, connective tissue disorder, or anatomical pathology. The thighbone (femur) has a V-shaped notch (femoral groove) at one end to accommodate the moving kneecap. If you buy through links on this page, we may earn a small commission. Early repair may prevent the tendon from scarring and tightening into a shortened position. On X-ray, with skyline projections, dislocations are readily diagnosed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. She had the same injury in December and missed five games but elected to have surgery after the recent injury. On the X-ray, the patella is usually up higher when compared to the opposite knee because the quadriceps pulls up on the kneecap, and nothing is holding it down in its normal position. The idea is that because the medial side is most often stretched by the more common lateral dislocation, medial strengthening will add more stabilizing support. If the kneecap is only partially dislocated, your doctor may recommend nonsurgical treatments, such as exercises and braces. During the physical examination, your doctor may ask you to walk around or to straighten and bend your knee. A new process allows surgeons to transplant cells that help a patient regrow cartilage in their knee. It means the sutures used to repair the tendon may have to be attached directlythrough the bone. When its working properly, the kneecap glides in a groove or cutaway thats near the end of your thighbone called the trochlear groove. Women who wear high heels tend to develop short calf muscles and tendons. Mostafavifar M, et al. (2012). Patellofemoral pain syndrome. Rotator Cuff and Shoulder Conditioning Program. Patients typically present with obvious deformity and an inability to extend the knee. 1972;160:740-742. Surgical repair involves reattaching the torn tendon to the kneecap. The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician.JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency Your surgeon will discuss your need for this extra protection before your patellar tendon repair surgery. Chronic disease. This article explains how the patellar tendon works and common injuries like a patellar tendon rupture (complete tear). The goal is for your injured leg to be at least 85 to 90% as strong as your uninjured leg. Find out why.Get to Know Houston. Patellar malalignment is a translational or rotational deviation of the patella to any axis, associated with several soft-tissue and osteochondral abnormalities and mostly characterised by a tilted and lateral displaced patella. The torn ends of the tendon need to be sewn together. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. [4] Rates in males and females are similar. Arthroscopic surgery can correct this condition. As with any surgery, other possible complications include infection, wound breakdown, a blood clot, or complications from the anesthesia. Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS, pain, and possibly swelling, in the front of the knee, that increases when you squat, jump, kneel, run, or walk downstairs, a popping, grinding, slipping, or catching feeling when you bend your knee, a feeling that your knee is buckling under you, weak thigh muscles (quadriceps), although theres. The kneecap is a separate bone thats attached to your thigh bone (femur) at the top and your big shin bone (tibia) by powerful tendons and ligaments. Patellar tendinitis. Your doctor may recommend you wear a knee immobilizer or brace. People who tear the tendon will be unable to extend their knee against gravity, and unable to perform a straight leg raise test. Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study. Usually, there is a reason for the patellar tendon to become weak, such as a systemic disease or recent knee surgery that led to a weakened tendon. The mechanism of the tape isnt certain. [2] Diagnosis is typically based on symptoms and supported by X-rays. Elbow dislocation. Your doctor and physical therapist will customize a rehabilitation plan for you. The kneecap moves out of place when the patellar tendon tears. (2017). About 2 weeks after surgery, you will have your skin sutures or staples removed in your surgeon's office. Encourages patellar tracking as the knee bends and flexes during exercise. [11] Normal function of the VMO muscle stabilizes the patella. Complications may include a patella fracture or arthritis.. A patellar dislocation typically occurs when the knee is straight and the lower leg is bent outwards when twisting. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. Physical therapy. Acute patellar tendon rupture with tibial tubercle avulsion repair using suture anchors: Tiny avulsed fragment which affects the strength of construction-a case report. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. The patellar symptoms cause knee extensor dysplasia, and sensitive small variations affect the muscular mechanism that controls the joint movements. A patella that slips laterally on early flexion is called the .mw-parser-output .vanchor>:target~.vanchor-text{background-color:#b1d2ff}J sign, and indicates imbalance between the VMO and lateral structures.[15]. If youre not getting good results from physical therapy, consider what other factors might be involved. The range of a normal Q angle for men ranges from <15 degrees and for females <20 degrees, putting females at a higher risk for this injury. [4], People often describe pain as being "inside the knee cap." The leg tends to flex even when relaxed. Chronic knee pain is long-term pain in one or both knees. DOI: Pal S, et al. We avoid using tertiary references. There are two types of knee locking: a true knee lock and a pseudo knee lock. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. If your doctor suggests that surgery will relieve the pain, discuss the reasoning fully. November 7, 2022. Call today to schedule an appointment or fill out an online request form. Avoid the most common mistakes and prepare your manuscript for journal editors. What Are Acute Injuries of the Patella (Kneecap)? Strengthening exercises will then be added to your rehabilitation plan. Elbow dislocation. Anatomy [citation needed], The patella is a triangular sesamoid bone that is embedded in tendon. Over time, your doctor or therapist will unlock your brace. However, tight and strong lateral quadriceps can be an underlying cause of patellar dislocation. They may order X-rays or MRI scans to help see if theres any other damage that may be causing your pain. Doctors generally only recommend surgery when other structures in the knee have sustained severe damage, or specifically when there is:[20], Supplements like glucosamine and NSAIDs can be used to minimize bothersome symptoms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625789/, Caylor D, et al. The Journal of bone and joint surgery. [4][5][3], Patellar dislocations occur in about 6 per 100,000 people per year. It usually requires surgery and physical therapy afterward to regain full knee function. Muscle weakness, poor tone, and structural abnormalities can cause you to be more susceptible to patellar tracking disorder. Considerations. Stuart Hershman, MD, is a board-certified spine surgeon. You may need a brace, crutches, physical. Kinesiology (kinesio) tape is a thin adhesive tape thats rigid in one direction and flexible in the other. The typical signs of a torn patellar tendon include: Patellar tendinosis, a term that reflects the degenerative (wear-and-tear) nature of the damage, describes this progressive weakness associated with basketball, volleyball, running, and other sports that put excessive strain on the knees. Clinically relevant anatomy [edit | edit source]. A common rehabilitation plan is to strengthen both the hip abductors, hip external rotators and the quadricep muscles. Arthroscopic surgery can correct this condition. Surgeons say the Calypso device can help relieve pain for people with osteoarthritis in their inner knee region. KSSTA Best Reviewer 2021, Thank you to all reviewers for supporting the journal in 2021, ESSKA - European Society of Sports Traumatology, Knee Surgery and Arthroscopy, SIGASCOT - Societ Italiana di Chirurgia del Ginocchio, Artroscopia, Sport, Cartilagine e Tecnologie Ortopediche, ISAKOS - International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine, EBSCO Rehabilitation & Sports Medicine Source, Japanese Science and Technology Agency (JST). But pain typically occurs immediately after you feel a snapping or popping at the knee. [12] Not having a groove because the trochlear bone has flattened out can cause the patella to slide because nothing is holding the patella in place. [4] Recurrence after an initial dislocation occurs in about 30% of people. A dislocation often damages the underside of the kneecap and the end of the thighbone, which can lead to additional pain and arthritis. Special attention typically is given to the VMO (vastus medialis obliquus), the part of the quadriceps on the inside of your thigh. Have you had a previous injury to the front of your knee? Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). One of the most important prognostic factors for recovery is the time to surgery, and surgery delayed beyond a few weeks can limit recovery ability. Additional symptoms include: Doctors use the knee extension test to help diagnose a patellar tendon tear. [citation needed], To assess the knee, a clinician can perform the Patellar Aprehension Test by moving the patella back and forth while the people flexes the knee at approximately 30 degrees. Complete tears can often be identified with these X-rays alone. I already have Osgood-Schlatter disease on my left knee which I also fractured (and has healed) last year, so realized that I'd need a good knee support if I run more than 10 miles.I have tried THREE (3) knee support braces/compression sleeves including I run a long distance and have recently developed a severe "runner's knee" on both sides of my knees. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) Get started with Adobe Acrobat Reader. To confirm the diagnosis, your doctor may order some imaging tests, such as an X-ray or magnetic resonance imaging (MRI) scan. The kneecap also may appear to slide up into the thigh if it's no longer anchored in place. does not Determining the Need for Surgery When You Feel Better Post-ACL Tear, Joint Subluxation Injury: Symptoms and Treatment, Acute patellar tendon rupture with tibial tubercle avulsion repair using suture anchors: Tiny avulsed fragment which affects the strength of construction-a case report, Current Concepts in the Treatment of Patellar Tendinopathy, Swelling and bruising in the front of the knee, A defect, or soft spot, where the tendon should be tight, Difficulty walking or doing sports activities. But studies havent shown conclusive evidence of a real improvement. Anterior cruciate ligament surgery is a complex operation that requires expertise in the field of orthopedic and sports medicine. Risks include: Although patellar tracking disorder is a common diagnosis for knee pain, theres controversy over whether its the root cause of many cases of knee pain. PMID: 27904789. If your surgeon does this, the wires or cables may need to be removed during a later, scheduled operation. But if the groove is uneven or too shallow, the kneecap could slide off, resulting in a partial or complete dislocation. Healthline Media does not provide medical advice, diagnosis, or treatment. Surgery to repair the torn tendon is relatively straightforward in concept but can be difficult to perform. Immobilization. X-rays may be recommended to see how the kneecap fits in its groove. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an Orthopaedist. This is a group of four separate muscles in your thigh that control knee extension and flexion. A systematic review and meta-analysis, Double level osteotomy for medial osteoarthritis and bifocal varus malalignment has excellent short-term results while maintaining physiologic radiographic joint parameters, Some, but not all, patients experience full symptom resolution and a positive rehabilitation process after ACL reconstruction: an interview study, Absorbable suture knots on the supraspinatus tendon prevent adverse effects of nonabsorbable suture knots in a rat model, No evidence exists on outcomes of non-operative management in patients with femoroacetabular impingement and concomitant Tnnis Grade 2 or more hip osteoarthritis: a scoping review, The 20th ESSKA Congress is in Paris, France on 27-29 April 2022, Congratulations! In a normal knee, the kneecap fits nicely in the groove. Direct impact to the front of the knee from a fall or other blow is a common cause of tears. One commonly recommended surgery is to make a cut in the ligament, the lateral retinaculum, that anchors the outer edge of the patella. Surgical modalities are: medial patellofemoral ligament reconstruction; trochleoplasty Find tutorials, the user guide, answers to common questions, and help from the community forum. Does Fascia Blasting Work and Is It Safe? You will be prescribed more strengthening exercises as you heal. Severe damage from the injury or underlying disease can also make the tendon too short. (2009). Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010. [14], An effective rehabilitation program reduces the chances of re-injury and of other knee-related problems such as patellofemoral pain syndrome and osteoarthritis. Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. (2018). Thank you, {{form.email}}, for signing up. It is considered after a second kneecap dislocation or if the knee is very unstable. DOI: Pavlou G. (2012). A hip dislocation is when the thighbone separates from the hip bone (). incidence. Very small, partial tears respond well to nonsurgical treatment. Usually a pre-existence ligamentous laxity is required to allow a dislocation to occur in this manner. Sex, size, and breed as risk factors in canine patellar dislocation. Surgery can stabilize the knee and lower the risk of the kneecap becoming dislocated again. Magnetic resonance imaging (MRI) may be used to confirm the diagnosis and inspect the knee for any other damage that may have occurred. A physical therapist will give you strengthening exercises, concentrating on the quadriceps. If the kneecap has been completely dislocated out of its groove, the first step is to return the kneecap to its proper place. [25] The treatment of the skeletally immature is controversial due to the fact that they are so young and are still growing. Hetrick C, et al. Re-tears sometimes occur, and the repaired tendon can detach from the kneecap. Can you exercise with a torn patella tendon? The J Patella Knee Brace by BraceAbility is one of our most popular patella stabilizing supports. ~2% following surgery. The strap isnt a solution for a chronic knee problem, though. Treatment is usually similar in athletes and non-athletes alike, however. The healthcare provider can usually feel the gap in the tendon, just below the kneecap. Most likely, your repair will be protected with a knee immobilizer or, rarely, a long leg cast. Other times, your doctor will have to apply gentle force to push the kneecap back in place. Alternate Technique. The tendon plays an important role in your ability to extend the leg in order to walk, climb stairs, run, and play sports. For example, surgery can be used to realign and tighten tendons to keep the kneecap on track, or to release tissues that pull the kneecap off track. Be aware that theres conflicting evidence about the efficacy of surgery for patellar tracking disorder. Complications. (2014). ___ Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. [citation needed], Another cause of patellar symptoms is lateral patellar compression syndrome, which can be caused from lack of balance or inflammation in the joints. Patellar (Kneecap) Fractures Distal Femur (Thighbone) Fractures of the Knee Fractures of the Proximal Tibia (Shinbone) Dislocation. While this part of the examination can be painful, it is important to identify a patellar tendon tear. A systematic review of the effectiveness of kinesio taping for musculoskeletal injury. Retrospective Case Review Following Physical Therapy Treatment for Patients with After 4 to 6 weeks, your leg should be able to handle your full body weight. [1] Commonly associated sports include soccer, gymnastics, and ice hockey. Youll also work on stretching and flexibility. Do you have any medical conditions that might predispose you to a knee or a patellar tendon injury? Weakened tendons can also be caused by diseases that disrupt blood supply, including: Steroid use. It can occur when the position of the thighbone relative to the shinbone, Patellar subluxation, or a dislocation of the knee cap, requires a diagnosis and treatment from a doctor. Using medications like corticosteroids and anabolic steroids has been linked to increased muscle and tendon weakness. [22], Rate in the United States are estimated 2.3 per 100,000 per year. For pediatric care, visitTexas Children's Hospital. Corticosteroid injections to treat patellar tendinitis have been linked to increased tendon weakness and increased likelihood of tendon rupture. The brace is equipped with a C-shaped buttress, which provides support against medial or lateral patellar subluxation, dislocations, improper patellar tracking, and more. Your doctor will consider several things when planning your treatment, including: Nonsurgical treatment most often includes wearing a brace and physical therapy. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Dislocation can occur following a series of events if the jaw locks while open or unable to close. Working together, the quadriceps muscles, quadriceps tendon, and patellar tendon enable you to straighten your knee. To find adult care, search by name, specialty or condition below. The above video demonstrates the mechanism of injury in patellar dislocation. Knee extensor strength does not protect against incident knee symptoms at 30 months in the multicenter knee osteoarthritis (MOST) cohort. Have you had surgery to your knee, such as a total knee replacement or an anterior cruciate ligament reconstruction? Partial tears. How patellar tracking disorders are diagnosed, Preventing patellar tracking disorder pain, kneeclinic.info/problems_patello_femoral.php, ncbi.nlm.nih.gov/pmc/articles/PMC5476763/. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Previous surgery around the tendon, such as a total knee replacement or anterior cruciate ligament reconstruction, might put you at greater risk for a tear. The difficulty lies in the fact that it is important to restore proper tension to the tendon, not making it too tight or too loose. DOI: Petersen W et al. Recovering from a torn patellar tendon is difficult and takes time. Deep lacerations are often associated with this type of injury. Patellofemoral pain syndrome: A review and guidelines for treatment. With progression more intense range of motion exercises are incorporated. You will most likely need crutches to help you avoid putting all of your weight on your leg. 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