Haklar U, Ayhan E, Ulku TK, Karaoglu S. Arthrofibrosis of the Knee. New media New comments. FOIA Incidentally noted is a hemarthrosis (11B) (with joint fluid appearing hyperintense to muscle) associated with an intra-articular fracture of the posterior tibia (asterisk). The goal of this series is to present our 10-year experience with this condition. Sometimes in the back of the knee too. Together we deliver everything you need to help your clients avoid or recover as quickly as possible from injuries. I love the work the SIB team is doing and am always looking forward to the next issue. At the end of the procedure the patient had a range of movement of -5 to 140 and negative Lachman, anterior drawer and pivot shift tests. already built in. A 66 year-old female 10 years post ACL reconstruction with intermittent locking. So just wanted to add that it seems like scar tissue can maybe still be an issue even if it doesn't form a true cyclops. Examination under anaesthesia revealed positive Lachman and anterior drawer tests (both showing 510mm of anterior displacement of the tibia) as well as a positive pivot shift test. It seems like it's been getting better because some of them have been getting easier, and before that I couldn't do a single leg squat, period (although if I go down too far, there's still pain). 36-40, Knee Surg Sports Traumatol Arthrosc, 2014. Apply a low load on top of the knee and hold this for a prolonged period e.g 15 minutes. Possible problems that can lead to the re-tear of the ACL include suboptimal positioning of the graft, improper tension on the graft, or failure of the fixation of the graft. A cyclops lesion (2.2 1.4 2.4 cm) was seen anterior to the ACL in the . An often overlooked code is 29884 Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure), which may be assigned for excision of fibrosis/adhesions/scar due to previous procedures or injuries. Lenny Macrina: Without knowing what excessive hyperextension means in the question, I'm going to assume it's that excessive like 10, 15 degrees of hyperextension, which is a lot for some people. Injury after AC. (2B) On the T1-weighted sagittal image, the nodular focus anterior to the ACL (arrow) is heterogeneous but almost isointense to the joint fluid and articular cartilage with subtle central areas of reduced signal. Simultaneously apply pressure down on the knee. Sports Injury Bulletin is the ideal resource for practitioners too busy to cull through all the monthly journals to find meaningful and applicable studies. During the past 3 decades, graft reconstruction of the anterior cruciate ligament (ACL) has become an accepted treatment for symptomatic ACL deficiency. Epub 2020 Jun 2. Athletes dont have to call it a day, Painful puzzles: the potent power of exercise, Time Crunch: strength training in triathletes. Neil Duplantier MD. AJR Am J Roentgenol. Patellofemoral compartment and medial tibiofemoral compartment cartilage loss. A cyclops lesion is a piece of scar tissue which develops on the anterior portion of an ACL. A second arthroscopy is then needed to remove the nodule of scar tissue in order to regain extension (2). when you sitting down and try to straighten your leg, its normal that you hear a pop or little force then pop, maybe double pop and relaxing. Got an MRI done and the report said: Complete rupture of the reconstructed ACL with Cyclops lesion Tear of lateral meniscus Ruptured popliteal cyst Multicomponent chondromalacia Conventional methods include elevation, compression with donut felt, effusion massage, and limited weight-bearing. 2015 Mar;73(1):61-4. 327-332, Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2009. MR imaging showed a well-defined, somewhat heterogeneous soft-tissue nodule with a signal intensity typically similar to that of skeletal muscle. It may be an incidental finding on a follow-up scan or if the knee is scanned for another reason. Thanks Pogo Physio! The functionality is limited to basic scrolling. The .gov means its official. Pogo physio has not only helped me get out of pain but has helped me become a better, happier runner. 2001 Feb;17(2):E8. doi: 10.3928/01477447-20120426-31. On MRI, cyclops lesions are adherent to the ACL graft and are hypointense or isointense to muscle on T1-weighted images and variable in signal intensity on proton density- and T2-weighted images.4 Rarely, areas of ossification within the cyclops lesion are well formed and large enough to be detected on MRI as circumscribed foci with internal signal that mirrors marrow fat signal on T1-weighted and fluid-sensitive sequences (Figure 4). One common complication of ACL reconstruction is a limited range of motion, especially obtaining a fully straight knee. Different aspects of the cyclops lesion following anterior cruciate ligament reconstruction: A multifactorial etiopathogenesis. Well, I just found out today that I completely tore the ACL in my right knee. (2007). Continued or recurrent tear of medial meniscus. I was reading about them on Google and some of the symptoms line up like the quad not fully coming back, audible clunking or occasional catching like I said when I try to fully extend it sometimes, but I have no loss of extension and can straighten both legs the same. I was going to go back to see him anyway, but wanted some opinions first if I should continue the exercises, or if it sounds like a cyclops lesion and I should go sooner than later. What are the findings? Arthroscopy: The Journal of Arthroscopic & Related Surgery, 26(11), 1483-1488. doi:10.1016/j.arthro.2010.02.034. The hallmark sign of a cyclops lesion is loss of knee extension range often about 2-3 months following an ACL surgery. Notify me of follow-up comments by email. MRI of the right knee ( Figure 3) showed a thickened patellar tendon, supra-patellar effusion, bone contusion and oedema in the anterior aspect of the tibial plateau as well as anterior and superior to the bony tract of the ACL repair. I did a few visits to physical therapy and they gave me exercises to do at home including wall squats, lateral step downs, single leg squats, and a few others. MAY 1951 No. The Pseudocyclops lesion is a rare complication of the arthroscopic reconstruction of the ACL in which a partial graft tear occurs and subsequently the torn fibres are flipped anteriorly mimicking a Cyclops lesion. Diffuse arthrofibrosis surrounding the ACL graft is rare. The repaired ACL was intact. Finally, a physical therapist can assist you with straightening your knee with various manual techniques, and advice for what you can do at home. New posts. A 32 year-old male 3 years post-ACL reconstruction with anteromedial knee pain. Fibrosis in the suprapatellar bursa typically limits knee flexion. Splinting or bracing may be used for extension deficits. I'm just asking here cause I'm wondering if I should give it another month with the physical therapy exercises and see what it feels like then/if it gets better, or if I should just go back to the doctor now and save some time. I had PF pain for months with squatting, but the reason I got the MRI was because I had some medial pain (where my meniscus repair was) after impact stuff, like jumping, and then when I was passed my running test, I couldnt hardly bear weight the next day, and couldnt run another step without severe pain for 6 weeks. MeSH I can squat and lift a lot of weight now with little pain, but my gait is a bit off. 3. Early pool work also provides hydrostatic pressure to aid with effusion drainage. The mechanisms are thought to be similar to the post-surgery presentation (7). Cyclops lesions are located just above the tibial tunnel and cause loss of knee range of motion with a mechanical block that restricts getting the leg completely straight following surgery. MRI of the right knee (Figure 3) showed a thickened patellar tendon, supra-patellar effusion, bone contusion and oedema in the anterior aspect of the tibial plateau as well as anterior and superior to the bony tract of the ACL repair. My surgeon still thinks it's scar tissue causing my issues. Methods After we performed prospective power analysis and obtained institutional review board approval, as well as patient consent, 64 patients were block randomized among 3 study sites to the aperture fixation group or . I cannot thank you all enough. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 8(1), 10-18. doi:10.1016/0749-8063(92)90129-y, Minne, C., Velleman, & Sulleman, F. E. (2012). A small amount of hyperextension of the knee is important, the knee should actually go about 5-6 past completely straight. ACL tears are a relatively common injury that if untreated can result in secondary osteoarthritis and meniscal tears 1, as well as an increased risk for reinjury of the knee. Clinical evaluation is the mainstay in establishing the diagnosis of arthrofibrosis, however MRI plays an important role in establishing the extent of involvement by fibrosis and to exclude other complications that may have a similar clinical presentation. The cyclops lesion, also known as localized anterior arthrofibrosis, is a painful anterior knee mass that arises as a complication of anterior cruciate ligament (ACL) reconstruction, although has rarely been reported in patients with ACL injuries that have not been reconstructed. 45(1): p. 87-97. All the staff, from Michael the physio, Sato the massage therapist and Matt at reception were wonderful. After briefly reviewing relevant normal ACL anatomy, we will review imaging findings of congenital ACL . That was back in December. One case has been reported previously following a bone-tendon-bone reconstruction of the ACL but a similar case has not been reported. described two histologic subtypes.6 The true cyclops is hard and composed of fibrocartilaginous tissue with active central bone formation and no granulation tissue or inflammatory cell infiltration.6 The true cyclops lesions are more likely to be symptomatic.7 The second type, termed a cyclopoid lesion, is soft and composed largely of fibrous and granulation tissue with occasional cartilaginous islands.6,4. The coronal T2-weighted image demonstrates diffuse heterogenous low signal fibrosis in the medial and lateral gutters (arrows). Log in. (84.6%), and accuracy (84.8%) of MR imaging of cyclops lesions in patients with persistent symptoms after ACL reconstruction. Sagittal fat-suppressed proton density-weighted (3A), sagittal T1-weighted (3B), and axial proton density-weighted images demonstrate a large heterogeneous cyclops lesion (arrows) anterior to the ACL graft. Jackson and Shaefer first defined cyclops syndrome in 1990.1 The location of this lesion is frequently anterolateral to the tibial tunnel. In one study, the incidence was 25% in the initial 6 months post-surgery, and 33% within two years. For 17 years, we've helped hard-working physiotherapists and sports professionals like you, overwhelmed by the vast amount of new research, bring science to their treatment. TECHNIQUE STEPS. HHS Vulnerability Disclosure, Help MRI is effective as a tool to evaluate unexplained pain, limited range of motion, and functional limitation in the postoperative patient in whom arthrofibrosis is suspected. Needless to say my injuries are now easily manageable with a great plan set up to suit my specific needs. 26(11), 1483-1488, J Orthop Res. Cyclops lesions can be found in up to 25% of ACL reconstructions at 6 months after surgery. For those not familiar, a cyclops lesion is a wad of scar tissue in the anterior aspect of the knee joint. A sagittal proton density-weighted image demonstrates a diffuse fibrotic reaction encasing the ACL graft with a cyclops lesion anterior to the ACL graft (arrow) and fibrosis posterior to the ACL graft (asterisk) extending to the posterior capsule. These lesions can also develop in knees that have had ACL injury without a reconstruction (3). The origin was thought to be due to residues of bone and cartilage from drilling of the tunnels. Also, moving your knee in & out of terminal extension helps develops hamstring and quadriceps control which can be lacking post-injury. Rehabilitation of soleus muscle injuries in distance runners, Uncommon injuries: sural nerve neuropathy, Dr. Alexandra Fandetti-Robin, Back & Body Chiropractic, Hamstring or not? Fig. It is considered a main complication of anterior cruciate ligament ACL reconstruction. Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years. 22:10901096, Current Orthopaedic Practice. It is believed to be a remnant of the previous ACL stump that had remained during the reconstruction surgery. The case studies are great and it just gives me that edge when treating my own clients, giving them a better treatment. Please enable it to take advantage of the complete set of features! National Library of Medicine We recommend a consultation with a medical professional such as James McCormack. Cyclops lesions developed within the first 6 months after surgery. He's worked with elite level State and National rugby and football teams in Australia, the UK and France. A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction. Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. The scarred synovium is hypointense to muscle on proton density-weighted and T2-weighted MR images (Figure 12).17. Following because this matches all of my issues to a T. I'm also a year and a half out, though I had a quad graft, and had a second surgery for more meniscus issues, bone spurs and cartilage blistering issues. Complications following primary ACLR using quadriceps tendon autograft were recorded in 10.5% of knees, with persistent knee pain being most common. A 40 year-old female who underwent revision TKA 1 year prior presents with catching and locking symptoms anteriorly when going from 90 degrees of flexion to full extension. A cyclops lesion (2.2 1.4 2.4 cm) was seen anterior to the ACL in the . I have been going to pogo for 2 years now. Arthroscopic excision is the treatment of choice for cyclops syndrome. A cyclops lesion is described as a focal anterior arthrofibrosis, which is an excessive formation of scar tissue on the anterior cruciate ligament. Cyclops Lesions That Occur in the Absence of Prior Anterior Ligament Reconstruction1. 2017 Jul 10;3(4):242-246. doi: 10.1016/j.artd.2017.06.002. Tonin et al reported it in patients with ACL injury without reconstruction surgery.4 In the absence of surgery, the origin was thought to be due to avulsion of pieces of bone from the attachment of the ligament. . The repaired ACL was intact. In 13 patients without cyclops lesions, the femoral tunnel entered the notch within 2 mm of the intersection of the intercondylar roof and the posterior femoral cortex. Only after surgical excision is physical therapy helpful in regaining mobility and strength. Lucas TS, DeLuca PF, Nazarian DG, Bartolozzi AR, Booth RE. Introduction. . A follow-up appointment at 2 months showed a limitation of extension of the knee with a fixed flexion deformity progressing to 10 over the next 4 weeks. Gandhi R, De Beer J, Leone J, Petruccelli D, Winemaker M, Adili A. Predictive risk factors for stiff knees in total knee arthroplasty. It is not a huge loss of extension, often less than 10, but its enough to be a problem (8). Previous studies reported that after ACL reconstruction, the incidence of joint stiffness was between 4 and 38% [8]. "The articles are well researched, and immediately applicable the next morning in the clinic. 2011, 22(4). Walk forward to increase the force pulling your knee into extension. Best of luck though. This has since been debated however the two surgeons were actually able to reduce their incidence of cyclops lesions by leaving less debris in the joint post-surgery (7). government site. I enjoy myself every time I walk into POGO! It is a frequent complication associated with surgery and trauma. Orthopedics. If you have decided that surgery is the best option, we take a look at the options for reconstruction and assess the pros and cons. Cyclops lesions develop in the anterior aspect of the intercondylar notch typically after anterior cruciate ligament (ACL) reconstruction or injury. Once these structures are inspected, the probe should be placed along the lateral side of the ACL, and the knee should be brought into a varus position or a figure-four . Cyclops syndrome should be suspected in any patient in whom an ACL nodule is identified at MR imaging, and similarly a cyclops nodule should be considered as a possible cause of loss of extension in any patient who has sustained ACL injury. ( a) Supine leg press with elastic band is initiated utilizing elastic band for closed-chain exercises. Focal areas of fibrosis following TKA are often seen in the peripatellar region and can present with mechanical symptoms. The reconstruction was performed using a four-strand hamstring graft and fixed on the femoral side using the TransFix technique and Bio-Interference screw (Arthrex, Naples, FL, US) fixation for the tibial side. Adhesions in the suprapatellar bursa can form between the capsular elements of the bursa and the medial or lateral gutters. eCollection 2009. In fact, autograft tissue (tissue from one's own patellar tendon or hamstring tendon) is stronger than the ACL. If the tibial tunnel is placed too far forwards in the intracondylar notch. By continuing to browse this site you are agreeing to our use of cookies. He offers Online Physiotherapy Appointments for 45. It could be that the old ACL stump has a protective effect on the graft. Knee Imaging Following Anterior Cruciate Ligament Reconstruction: The Surgeons and Radiologists Perspectives. We now report such a case. Muellner T, Kdolsky R, Groschmidt K, Schabus R, Kwasny O, Plenk H. Cyclops and cyclopoid formation after anterior cruciate ligament reconstruction: Clinical and histomorphological differences. Apr 11, 2013. A cyclops lesion is described as a focal anterior arthrofibrosis, which is an excessive formation of scar tissue on the anterior cruciate ligament. RadioGraphics, 27(6), e26-e26. Brad and the whole team make every visit there so pleasant. Yes. Home. All patients had a history of trauma but no history of ACL reconstruction. Runyan, B. R., Bancroft, L. W., Peterson, J. J., Kransdorf, M. J., Berquist, T. H., & Ortiguera, C. J. Together they have got me moving pain free. Arthroscopic treatment of the arthrofibrotic knee. Ann R Coll Surg Engl. There are four main tissue options for surgery: kneecap tendon with bone. The appearance and clinical history are suggestive of patellar clunk syndrome. At least that's one theory. Bone debris from drilling during the ACLR. A band of low signal extends over the posterior aspect of the infrapatellar fat pad (short arrows). eCollection 2019 Dec. Arthroplast Today. Cyclops, inverted; Anterior cruciate ligament reconstruction; Complication, Annals of The Royal College of Surgeons of England, Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction, Extension loss secondary to femoral-sided inverted cyclops lesion after anterior cruciate ligament reconstruction, Arthroscopic findings associated with roof impingement of an anterior cruciate ligament graft, Progressive loss of knee extension after injury. The ePub format uses eBook readers, which have several "ease of reading" features The accuracy and reproducibility of magnetic resonance imaging (MRI) scans in . Patrick C. McCulloch MD. Activation and strengthening of your quadriceps muscles will provide you will more power to extend your knee and keep it straight with functional tasks like standing and walking. And I've stopped running for now. I also expla. An 18 year-old female college athlete presents 6 months following ACL reconstruction with locking and catching. Well trained, friendly and professional. that surgery was so, so much easier than the first and eliminated a ton of my pain related to the scar tissue and limited mobility. Menu Related Articles: Large graft relative to intracondylar notch, slightly higher incidence with double bundle compared to single bundle for this reason. 2010. Couldnt recommend him highly enough. It is accepted that the origin is multifactorial.4 Cyclops syndrome has been reported following different types of grafts and procedures. MRI has been shown to be 84% accurate in detecting cyclops lesions (2) and surgical intervention is generally successful in restoring knee function (8). A 60 year-old male 4 years post TKA complains of pain and popping of the knee with walking for the last 6 weeks. Cyclops lesions occur in the minority of cases of ACLR surgery, between 1-10%. A femoral-sided cyclops lesion has not been reported following hamstring reconstruction of the ACL. We report the case of an inverted cyclops lesion limiting extension of the knee joint after a four-strand hamstring anterior cruciate ligament (ACL) reconstruction. Disclaimer. 8.2. A Cyclops lesion is a complication following an ACL injury which occurs in about 5% of cases. The risk of cyclops lesions is between 1-10% of ACLR surgeries. This has all been terribly frustrating for me, so I'm sure it is for you too. TECHNIQUE VIDEO. The moniker of cyclops lesion was given based on the arthroscopic appearance of the fibrous nodule and vessels that resemble an eye. The American Journal of Sports Medicine, 29(5), 664675. In the knee, arthrofibrosis most often occurs following anterior cruciate ligament reconstruction and total knee arthroplasty and represents a potentially devastating complication. It is a frequent complication associated with surgery and trauma. Sanders TL, Kremers HM, Bryan AJ, Kremers WK, Stuart MJ, Krych AJ. Another theory states that it may be fibrocartilage as a result of drilling the tibial tunnels. Select appropriate exercises, like quadriceps exercises performed in positions of partial (20) knee flexion or isometric squats in 20-30 flexion. This may be due to a what is termed a Cyclops Lesion. He works in private practice. Limitation of extension is one of the complications after anterior cruciate ligament (ACL) reconstruction commonly caused by a cyclops lesion, which is most frequently seen in the anterior aspect of the knee arising near the tibial attachment of the graft. Debridement of cyclops lesions after total knee replacement (s) is a . In severe cases of infrapatellar fat pad arthrofibrosis, fibrosis between the patella, patellar tendon, and tibia can result in severe retraction and tethering of the patella leading to patella baja which may become progressive (patella infera). Arthrofibrosis is a common complication of ACL reconstruction and total knee arthroplasty and can result in a frustrating clinical course and poor functional results. The cyclops lesions had a mean size of 16 x 12 x 11 mm, with 90% of them located just anterior to the distal ACL. If a cyclops lesion is suspected, you will need to return to your orthopaedic surgeon and likely have an MRI to confirm the presence of the scar tissue. Sagittal T2-weighted (1A) and T1-weighted (1B) images through the ACL graft and a coronal oblique proton density-weighted (1C) image anterior to the ACL graft are provided. The exact aetiology is uncertain. 2. This is sometimes referred to as a "Cyclops lesion" or arthrofibrosis. Your email address will not be published. Sequential sagittal T2-weighted images demonstrate a thickened band of fibrosis along the anterior interval of the knee (arrows). Graft failure is defined as pathologic laxity of the reconstructed ACL. A MRI looking from the side shows the cyclops lesion (dark patch) protruding anteriorly. Arthrofibrosis of the knee with a cyclops lesion anterior to the ACL graft, fibrosis of the anterior interval, and posterior pericapsular fibrosis. Latest reviews. Early return of full extension will reduce your risk of developing a cyclops lesion. I'm trying to work thru it with more PT first. This is not medical advice. The cyclops lesion is a nodule of scar tissue that has grown in the front of the knee joint The cause of cyclops lesions is likely multi-factorial but may be linked to debris in the joint The hallmark sign of a cyclops lesion is loss of extension post-surgery Patients usually also have anterior knee pain and quadriceps dysfunction https://www.pogophysio.com.au/wp-content/uploads/pogo-physio-with-a-finish-line2x.png, https://www.pogophysio.com.au/wp-content/uploads/acl-surgery-cyclops-lesions.jpg. . An official website of the United States government. The site is secure. MR imaging showed a well-defined, somewhat heterogeneous soft-tissue nodule with a signal intensity typically similar to that of skeletal muscle. At least that's one theory. Etiology of total knee revision in 2010 and 2011. First described in 1990 by Jackson and Schaefer (1), a cyclops lesion is a reasonably common complication following anterior cruciate ligament reconstruction (ACLR), with the majority being benign and asymptomatic (2). Unable to load your collection due to an error, Unable to load your delegates due to an error. Despite such prevalence, cyclops lesions generally have minimal or no clinical symptoms, and their presence does not portend an inferior clinical outcome, with only 2% of cyclops lesions prompting surgical intervention.9 Symptomatic lesions present with loss of extension, snapping, catching, and painful extension with walking and/or running resulting in the cyclops syndrome. 7,8, MRI can assist in distinguishing cyclops lesions from other pathology that may limit knee extension, including roof impingement of the ACL graft (Figure 5), intra-articular bodies (Figure 6), and displaced torn ACL graft fibers. A cyclops lesion can occur as a result of trauma without surgery and can be the result of a partial ACL tear or complete ACL rupture. It occurs as a result of anterior cruciate ligament ACL reconstruction. The post-operative recovery was uneventful. Cyclops lesion after ACL Reconstruction When patients struggle to regain extension after ACL reconstruction, one of the important things to exclude is the 'cyclops' lesion. Sagittal T2-weighted and T1-weighted images demonstrate a cyclops lesion anterior to the ACL graft (arrows) containing an ossified focus (arrowheads) compatible with a hard cyclops lesion. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts, however persistent knee pain was 2.7x greater with use of a soft tissue quadriceps graft. Background. SARMS. These lesions result in pain and loss of extension with impingement of the lesion. At present, increasing the accuracy of identification of knee ligament insertions is fundamental in developing accurate patient-specific three-dimensional (3D) models for preoperative planning surgeries, designing patient-specific instrumentation or implants, and conducting biomechanical analyses. All patients had a history of trauma but no history of ACL reconstruction. i dont have idea about the other issues. It said I had inflammed patella tendon and Hoffa's fat pad. The lesion is a focal anterior arthrofibrosis which consists of fibrous tissues and may or may not include cartilage and bony components (5). Bull Hosp Jt Dis (2013). He is incredibly thorough in his assessment, diagnosis and explaination of both the injury and the process of rehab. No cyclops lesion or scar tissue noticed. 48 year-old male with sagittal T1-weighted images at the time of the ACL tear (11A) and 2 years later after a fall (11B) demonstrates the development of severe scarring within the infrapatellar fat pad and posterior to the patellar tendon with interval inferior displacement of the patella. "The procedure to repair a torn ACL is called a reconstruction, and the torn ligament is replaced with a tendon. The cyclops lesions had a mean size of 16 x 12 x 11 mm, with 90% of them located just anterior to the distal ACL. Arthroscopy . Increased preoperative and postoperative inflammation reflected by swelling, effusion, and hyperthermia also plays an important role in the development of this complication.7,11 On MRI, fibrotic tissue encases the ACL graft and can extend anteriorly into the infrapatellar fat pad and suprapatellar bursa or posteriorly to the posterior joint capsule (Figure 8).7. 1990. Initially, a more aggressive physical therapy regimen is attempted along with anti-inflammatory medications.
cyclops lesion without acl repair
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