oblique tear of medial meniscus

Clinical: Most trauma to knee joint is caused by a lateral blow at knee level when foot is planted when knee is slightly flexed. In rare cases secondary signs can be seen, such as a soft tissue swelling next to the meniscus when a meniscal cyst is present 4. The device is small and contains a light and a camera, which transmits images from inside the knee onto a monitor. Walking can become difficult. Patients with ACL tears are also thought to be better candidates for meniscal repair because of the presence of serum-derived growth factors within the hemarthrosis that accompanies ACL tears.15. The menisci act as cushions between your shin bone (tibia) and your thigh bone (femur). An awkward twist when getting up from a chair may be enough to cause a tear in an aging meniscus. In sports, a meniscus tear usually happens suddenly. An MMPH repair in an ACL-deficient knee showed a significant decrease in anterior-posterior tibial translation at all flexion angles except 60 compared with the ACL-deficient/MMPH tear state . Because these two tear patterns differ greatly in prognosis and treatment approach, vertical is therefore not the preferred descriptor for such meniscal tears, unless paired with the proper category, such as vertical longitudinal. 1871 LPGA Blvd., Daytona Beach, FL 32117. Vincken PW, ter Braak AP, van Erkel AR, et al. One of the main tests for meniscus tears is the McMurray test. The medial meniscus is an important secondary stabilizer of the knee. from the American Academy of Orthopaedic Surgeons, Questions and Answers for Patients Regarding Elective Surgery and COVID-19. (redirected from Oblique Tear) The most common meniscal tear, a type of radial tear which begins at the free (inner) edge like other radial tears, but then curves into a longitudinal orientationsimilar to longitudinal meniscal tearsas the tear extends toward the meniscal periphery. Gillquist J, Hamberg P, Lysholm J. Endoscopic partial and total meniscectomy. Any tears appear as white lines. Nonsurgical treatment is an option for elderly patients, those with significant comorbidities and those with advanced OA (Outerbridge grade 3 or 4 chondromalacia of the ipsilateral compartment). To learn more, please visit our. 16 OShea JJ, Shelbourne KD. Extrusion of the medial meniscus (MM) is associated with knee joint pain in osteoarthritic knees. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. Although some reports have described successful repair of the avascular portion of the meniscus,11 it is generally accepted that meniscal repair is more likely to be successful if it involves or at least communicates with the meniscal red zone, lying within three to four millimeters of the capsular rim.12 A basic principle of meniscal repair is to rasp the tear edges and the parameniscal synovium above and below the meniscus, which is thought to enhance the vascular healing process. Procedure. Seldom are they the sign of a problem. Clinical results of meniscus repair in patients 40 years and older. Fat-suppressed proton density-weighted (4a) sagittal and (4b) coronal images reveal a horizontal tear of the posterior horn of the medial meniscus (arrows), extending to the tibial surface. Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). Immediate conservative measures include the RICE regimen: Longer term measures include activity modification, nonsteroidal antiinflammatory drugs (NSAIDs) and physiotherapy.4,1921 Nonsteroidal anti-inflammatory drugs are often recommended for 812 weeks,20 although paracetamol can be considered if NSAIDs are contraindicated or poorly tolerated.22 Where available, intensive physiotherapy is very useful and should include range of motion, proprioceptive work and muscle strengthening exercises. Missouri: Mosby, 1998. The healing time in children is a little less as the healing process is faster in children than in adults. Coronal proton weighted MRI of horizontal tear of lateral meniscus (white arrow) with complicating ganglion (black arrow) at the lateral margin of the meniscus, Australian Family Physician was the peer-reviewed, scholarly journal of The Royal Australian College of General Practitioners (RACGP) from 1971 to 2017. Bove SE, Flatters SJ, Inglis JJ, Mantyh PW. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Because there is no supply, there is little capacity for these tears to heal on their own. RICE. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Reciprocally, an increased force is also placed on an ACL graft with a deficient medial meniscus. (5a) A longitudinal tear of the posterior horn of the medial meniscus is illustrated. 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. Nourissat G, Beaufils P, Charrois O, et al. I could not really walk on it. I have been diagnosed with a subtle oblique tear involving the posterior horn of the medial meniscus and extends to the inferior articular surface of the meniscus. 17 Old Kings Road N., Suite K Palm Coast, FL 32137, East Coast Surgery Center Complex tears like this are likely to be unstable. Recent kinematic/biomechanical studies have also shown the importance of the medial meniscus to anterior translation of the knee. A torn meniscus often can be identified during a physical exam. What is Meniscus Radial Tear. Knowing where and how a meniscus was torn helps the doctor determine the best treatment.. In the present case, a full-thickness radial tear of the medial meniscus is visualized (Fig 1).An arthroscopic torpedo shaver (Arthrex, Naples, FL, U.S.A.) is used to debride the meniscus tear edges back to a healthy, stable rim (Fig 2).For improved access to the medial meniscus, an 18-gauge spinal . When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. However, anyone at any age can tear the meniscus. It presents as a wedge-shaped defect resembling a parrot beak at the free edge of the meniscus as a result of displaced oblique vertical orientation. Historically, medial meniscal root tears have been treated conservatively or by partial meniscectomy. The younger population, particularly males with knee instability, is most commonly affected by this type of tear [56]. This is what my MRI says: Radial tear poster medial meniscus, degeneration fraying medial meniscus, moderate bone contusion medial tibial plateau with degenerative changes, moderate bakers cyst.My doctor says I should get a clean-up on my knee. w/severe pain? Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. He/she will probably recommend surgery. Treatment of meniscal tears includes simple observation, meniscectomy, and meniscal repair. Non-operative treatment of degenerative posterior root tear of the medial meniscus. type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Tears that are stable, < 1 cm in length, and that do not cause significant . MR is also able to assess the stability of meniscal tears,6 an important factor, as unstable tears require operative treatment for symptom relief. In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. If you continue to use this site we will assume that you are happy with it. 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. A tear can also develop slowly as the meniscus loses resiliency. 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. (9a) This irregular tibial surface tear (arrow) clearly lies within the peripheral, red zone, of the meniscus. Meniscal tears may be categorized into five common configurations, including horizontal, longitudinal, radial, oblique (parrot-beak), and complex. Radiographs may or may not show medial joint space narrowing. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. Fax These imaging pearls improve recognition of meniscal root tears (Figure 2). The lateral meniscus is on the outermost side of your knee, so the tear location is outside-front. It is important to describe your symptoms accurately. The medial meniscus is the cushion that is located on the inside part of the knee. . The views expressed by the authors of articles in Australian Family Physician are their own and not necessarily those of the publisher or the editorial staff, and must not be quoted as such. The loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). It has the shape of two C's. The medial meniscus is the C shape on the knee's inner side, and the lateral meniscus is the C shape on the outer side of the knee. AJR 2003; 180:93-97. (12a) A radial tear (arrow) truncates the central attachment/root of the posterior horn of the medial meniscus on this fat suppressed proton density-weighted coronal image. If you prefer, you can also fill out our appointment request form online now. Sometimes these tears require surgical repair. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. If this cartilage tears, the result is pain, stiffness, and swelling. Other established anatomical variants include the transverse meniscal ligaments and the meniscofemoral ligaments, which mimic meniscal tears at their meniscal attachment sites. Treatment or management protocols for posterior horn menial meniscus tears are quite challenging. Peripheral meniscal tears are located in the most vascular portion of the menisci and comprise 39-72 % [2, 3, 56, 69, 82] of all meniscal tears. J Bone Joint Surg Am 2005;87:71524. Transtibial pullout repair is a new arthroscopic technique to repair meniscal root tears, . Those that extend through the entire width of the meniscus are particularly harmful (16a,16b), and even if such tears appear stable following repair, they are unlikely to regain the ability to provide hoop stress to the meniscus.13 Radial tears have therefore classically been treated with partial meniscectomy, though evolving surgical techniques have led to successful reports of the repair of radial tears that communicate with the meniscal periphery.11 A recent report has even described the successful repair of radial tears of the medial meniscal root,14 utilizing a tibial tunnel through which sutures are placed in the avulsed meniscus, a technique similar to that used in patients undergoing meniscal transplantation. The doctors at the Orthopaedic Associates of Central Maryland are here to repair your knee problems, hip pain, and arthritis issues so you can get back to enjoying life. The treatment of these type of tears can be either arthroscopy (surgery through a tiny hole in knee) or conservative. Sagittal peripheral meniscal images demonstrate the normal anatomical 'bow-tie configuration' (the central meniscal body with the anterior and posterior horns as well circumscribed triangles. There are two menisci, a medial one on the "inside" of the knee and a lateral one on the "outside" of the knee. Medial meniscal root tears are more frequently diagnosed in patients who are older than 40 years, are overweight and cannot recall an inciting event. Chahla and Geeslin report no relevant financial disclosures. Rehabilitation of the knee following sports injury. The treatment your doctor recommends will depend on a number of factors, including your age, symptoms, and activity level. Your doctor will generally ask you how the injury occurred, how your knee has been feeling since the injury and whether you have had other knee injuries. Both of them have 2 causes. AJR Am J Roentgenol 1998;170:5761. Biomechanical studies have demonstrated that repair of medial meniscus posterior root tears leads to improved contact mechanics. An experimental study in dogs. Your doctor will bend your knee, then straighten and rotate it. 5 Horizontal tears, the most common meniscal tear pattern, lie parallel to the tibial plateau and separate the meniscus into upper and lower parts (4a,4b). As recognition of the critical function of the menisci in normal biomechanical function of the knee has grown, attempts at preserving meniscal tissue via repair as opposed to partial meniscectomy have also gained favor. Mri of knee shows "oblique tear posterior horn medial meniscus, lateral patellar plica and minimal synovial knee effusion" will i need surgery? Each knee joint has two crescent-shaped cartilage menisci. An oblique tear (7a,8a) is often referred to as a parrot-beak tear, as the tear shape resembles a parrots beak. As people age, they are more likely to have degenerative meniscus tears. Symptoms of a meniscus tear. Intrasubstance/incomplete tear (top left) This type of tear is often a sign of degenerative changes in the meniscus tissue. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. A case also can be made for medial meniscal root repairs for a symptomatic acute and possibly a chronic medial meniscal root tear in a non-obese patient older than 40 years with a MRI that does not have early arthritic changes. 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). Operative Arthroscopy, 3rd Edition, 2002, Lippincott Williams and Wilkins. 1. 9 Lecase LK, Helms CA, Kosarek FJ, Garret WE. A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. The tear results in a vertical signal abnormality on sagittal MR images. X-rays provide images of dense structures, such as bone. Depending on the severity of the injury, surgical repair may or may not be needed. From January 2018, it was superseded by AJGP: Australian Journal of General Practice, The Royal Australian College of General Practitioners 2021. All rights reserved. Referral to an orthopaedic surgeon is important if the diagnosis is uncertain or there is minimal improvement at clinical review. The identification of the meniscus comma sign . The vascularity of the peripheral menisci is primarily derived from the Arthroscopic repair An arthroscope is inserted into the knee to see the tear. Depending on your duration of symptoms you can at least start off with physical therapy, a knee sleeve, and if there is arthritis present consider a c Dr. Christopher Ferguson and another doctor agree. The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. Following root repair, patients are required to remain non-weight-bearing for 6 weeks. Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. https://orthop.washington.edu/patient-care/articles/sports/torn-meniscus.html, Phone Also write down any new instructions your provider gives you. In addition to the root tear, the MRI often shows chondral loss or fissuring, other areas of meniscal tearing, bone marrow edema or osteophyte formation (Figure 5). The relationships among MM radial/oblique tears, MM extrusion (MME), and the effect of arthroscopic meniscal repair are not established. Clin Orthop Related Res 2010;468:11902. The operative equipment needs and post-operative rehabilitation process markedly differ between meniscal repair and partial meniscectomy. X-rays. 2010. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. 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. The knee: a comprehensive review. With meniscal repair, weight bearing may be severely limited for up to six weeks following surgery, and protection from heavy stress to the knee extends for up to six months. Biomaterials 2011;32:741131. A tear can also develop slowly as the meniscus loses resiliency. and oblique tear . These tendons have poor blood supply and will not heal themselves. Br Med Bull 2007;84:523. 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. Successful outcome and patient satisfaction after medial meniscal root repair are established initially upon appropriate diagnosis and patient selection. Am J Sports Med 2006;34:91927. A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. The first one is traumatic and the second one is a degenerative meniscal tear. In this short surgical video, a degenerative meniscus tear is smoothed down with a motorized shaver during a partial meniscectomy. The primary objective is to control the disease process to avoid the complications . Meniscal tear incidence may be as high as six per 1000 population6 with a 2.5 to 4 times male predominance. Figure 1. Those with a meniscus tear are also more likely to develop osteoarthritis in the injured knee. New advances in musculoskeletal pain. The meniscus is a thick cartilage structure that sits between the bones of the knee. Both of these factors increase contact forces across the joint, leading to accelerated osteoarthritis and predisposing the patient to the development of subchondral insufficiency fractures.7. Additional pain may be felt when flexing or twisting the knee. I have an oblique tear of the posterior horn of the medial meniscus, what is the treatment for that? Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. It is generally divided into 3 separate portions, the anterior horn, the mid-body and the posterior horn. A flap tear is a descriptive term that refers to a situation where the meniscus tears within its midsubstance, usually in a predominantly horizontal pattern, and then the upper or lower component of the torn meniscus becomes displaced from its site of origin (14a).8 These tears are most common at the medial meniscal body, and when displaced, the flap component may migrate into the superior or inferior meniscal gutter (15a,15b). Because other knee injuries can cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis. 1 article features images from this case ICD 9 Codes: 717.4 derangement of the lateral meniscus 717.3 derangement of the medial meniscus 836.0 lateral meniscus tear 836.1 medial meniscus tear Case Type / Diagnosis: Functional Anatomy: The menisci are semi lunar shaped cartilages on the medial and lateral sides of the knee joint. This type of tear is particularly devastating to meniscal function. 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. AJSM 1999; 27:242-250. Know what to expect if you do not take the medicine or have the test or procedure. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. Meniscus Surgery. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. AJSM 2003; 31:216-220. Choose a doctor and schedule an appointment. Illustration and photo show a camera and instruments inserted through portals in a knee. You will start with exercises to improve your range of motion. Usually you will be able to leave the hospital the same day. AJSM 2002; 30:589-600. 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. 1175 Dunlawton Ave., Suite 101, Port Orange, FL 32127, Palm Coast The degenerative aetiology and reduced vascularisation secondary to ageing also means that meniscal tears in the elderly population are less likely to be amenable to surgical management;7 only about 6% of patients over 40 years of age have operable lesions.24 To prevent re-injury of the meniscus, activity modification is important for example, ceasing sports such as soccer or netball. Orthopedics 2009;32:8. This puts tension on a torn meniscus. A horizontal meniscus tear runs along the circumference of the fibers of the meniscus. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. Barrett GR, Field MH, Treacy SH, Ruff CG. Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. The posterior horn is located on the back half of the meniscus. 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. Two months later, the post-operative image (17b) reveals a repaired, normal appearing lateral meniscal body (arrow), with resolution of the previously seen displaced fragment. The anterior horn of the medial meniscus demonstrates half of the normal anatomic 'bow-tie configuration'. The posterior horn it the back portion of the menisci at the end of the curve, where it tapers . (16a) Sagittal and (16b) axial proton density weighted images reveal a very large radial tear (arrows) that extends broadly across the entire width of the anterior body of the lateral meniscus. A gradient-echo T2*-weighted sagittal image demonstrates a tear within the posterior horn of the medial meniscus (arrow). 4 Hauger O, Frank LR, Boutin RD, et al. Even better would be to describe a peripheral longitudinal tear extending to the tibial surface within the posterior horn of the medial meniscus! swelling . Singapore: World scientific, 2010. Oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. Rotator Cuff and Shoulder Conditioning Program. London;1897. The RICE protocol is effective for most sports-related injuries. Garrett WE Jr, Swiontkowski MF, Weinstein JN, et al. The medial meniscus has a firmer capsular attachment than the lateral meniscus. Meniscus tears are among the most common knee injuries. Many tears are repaired with dartlike devices that are inserted and placed across the tear to hold it together. Repair of such lesions can result in dramatic clinical as well as MR imaging results (17a,17b). The medial meniscus is the portion of the cartilage along the inside of the knee joint (closest to the other knee). When displacement is not evident on MR images, additional criteria that suggest tear instability include the presence of fluid signal intensity within the tear on T2-weighted images, a tear that is greater than 10mm in length, and tears with complex patterns (10a). w/severe pain? 1890 LPGA Blvd., Suite 240 Daytona Beach, FL 32117, Port Orange North & South Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Medial meniscus tears are most frequently addressed with a partial meniscectomy, which involves arthroscopically removing the damaged portion of cartilage. Skeletal Radiol 2007;36:14551. Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. 10 DeHaven KE. At The Orthopedic Clinic, we want you to live your life in full motion. Matthew H. Blake, MD, can be reached at the Kentucky Clinic, 740 Limestone, Suite K415, Lexington, KY 40536; email: Darren L. Johnson, MD, can be reached at the Kentucky Clinic, 740 S Limestone, Suite K415, Lexington, KY 40536; email: Jorge Chahla, MD; Andrew G. Geeslin, MD; and Robert F. LaPrade, MD, PhD, can be reached at Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Dr., Suite 400, Vail, CO 81657; Chahlas email. If your meniscus tear is not severe, your doctor will likely recommend the following treatment: If you have a meniscus tear, physical therapy can help to strengthen the muscles around the knee as well the muscles in your legs which in turn will stabilize and support the knee. 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. Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. All rights reserved. Br Med Bull 2011;2011:89106. This provides a clear view of the inside of the knee. Meniscal repair using an exogenous fibrin clot. Strengthening exercises will gradually be added to your rehabilitation plan. J Fam Pract 2001;50:93844. 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. With a bucket handle tear, a tear forms in the center of your meniscus. McMurray test: The patient lies supine on the bed with the hip and knee both flexed. Meniscal intra-substance signal abnormalities are defined as an increased signal that does not fulfill the criteria for a meniscal tear according the "two-slice-touch" rule (i.e., it does not reach the meniscal surface on two consecutive views) and is a common finding on routine MRI of the knee (Fig. Meniscal injury and repair: clinical status. They will manipulate your leg into various positions, observe you while you walk, and bend at the knee. The medial meniscus is on the innermost side of your knee (the C-shaped curve faces in toward your body, the opposite knee). Cole BJ, Dennis MG, Lee SJ, et al. Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. Case Discussion Longitudinal tears, also known as vertical tears, occur perpendicular to the tibial plateau and parallel to the long axis of the meniscus splitting the meniscus into inner and outer parts. Oblique tears commonly cause flaps and flaps are generally not good. Knee arthroscopy is one of the most commonly performed surgical procedures. 1165 Dunlawton Ave., Suite 102 Port Orange, FL 32127, Port Orange East & Walk-In Clinic The second patient reviewed in this video is an 11-year-old girl who fell while playing tag and hit the front of her left lower leg. In younger patients, this is typically a twisting force on a weightloaded flexed knee. This information is not intended as a substitute for professional medical care. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. For patients whose procedures have not yet been rescheduled:What to Do If Your Orthopaedic Surgery Is Postponed. The tear should be eight millimeters or more in length, as shorter peripheral longitudinal tears are less likely to be symptomatic and may heal spontaneously. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. 2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi Medial Meniscus: oblique tear of the posterior portion with a separated and unstable fragment. I have an oblique tear of the posterior horn and body of the medial meniscus extending to the inferior articular surface. Thessaly test: The clinician holds the patient's outstretched hands for support, while the patient stands flat-footed with their knee flexed to 20 degrees and rotates their body and knee three times, internally and externally. Makris EA, Hadidi P, Athanasiou KA. Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review.

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