Im praying that it goes this way, since Im an active person and am having an actual depression as I write this. Jonathan Cluett, MD, is board-certified in orthopedic surgery. Note on the boot. During the retraction, the nerve can be irritated with too much tension. Bunion surgery (including Tailors bunion), Comprehensive arthroscopic management (CAM), Open reduction and internal fixation (ORIF), Foot and ankle, limb reconstruction & bone infection, What to expect after ankle ligament reconstruction surgery, Bruising, pain and swelling are typical, but it may still be possible to put a certain amount of weight on your foot, A feeling that your ankle is catching or locking, Lack of stability in your ankle causing the ankle to give way frequently, Possible ankle dislocation or osteochondral injury (defect in the cartilage at the tip of the bones). Ankle replacement might not be a good choice if you: Are younger than 50; Have weakened ankle ligaments; Participate in high-impact . Youll probably need to use crutches and keep weight off your ankle for at least a few weeks. Knee Surg Sports Traumatol Arthrosc. Be careful of those knee scooters. Edited by Eric Malicky, MD Indication. Then there are the crutches followed by walking boot and extensive physical therapy. There is some numbness on the skin and still get a bit of pain in my ankle too. By morning I could move my toes, and the pain level was probably at no more than a 2. The surgery may take 2 or more hours. to me it happened yesterday. Ankle ligament reconstruction is a surgical procedure that tightens the outside or lateral ligaments of the ankle. Memory usage: 66432.0KB, Fibula Stress Fracture: Symptoms, Treatment and Prevention, 9 Best Double Chin Exercises That Work Fast. The arthritis damage is less easy to fix, but a technique called micro-fracturing of the bone makes it possible for the body red blood cells to escape and regrow some insulating material where the cartilage had formerly been. Theres a mental shift, but it happens fairly quickly. San Francisco, CA 94123, United States. So far very little pain. If you have had repeated ankle sprains or if you have certain foot deformities, your ligaments can start to get weak and loose. Pain stopped being severe, Im off opioids and can sleep. 14,22 The lateral ligament complex includes the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament. The nerve block lasts about 12-18 hours. And 6 weeks in an air cast boot (Im from the UK) What are peoples opinions on this as I dont want to go into this very nieve? References: Brigham and Women's Hospital: Modified Brostrom-Gould Repair; University of Wisconsin Sports Medicine: Rehabilitation Guidelines for Lateral Ankle Reconstruction; Journal of Orthopaedic Surgery and Research: Treatment of chronic lateral ankle instability: a modified brostrom technique suing three suture anchors; Sports Physical Tell your healthcare provider about all the medicines you take. You can discuss the risks that most apply to you. Patients undergoing the surgery are subject to the potential for the usual risks associated with surgery such as the risk of: This procedure is designed to effectively treat ankle instability. I woke up. Aircast splint for sleeping at night (make sure sheets/covers are not pushing foot down into plantarflexion). During lateral ankle ligament reconstruction, the surgeon makes a small cut on the outside of your ankle. The drugs did their job and I felt fine and only slightly loopy. Im hoping surgery, plus vigilance, plus exercises and strengthening will. I was able to get around. On the left, the ACL fibers are loose, wavy and poorly organized. Wrong. Im 6 days loose surgery and feel like im making a fuss with the pain. The one thing that remains is a strong stinging electrical type pain in the surgery area, whenever the foot goes down. Ankle arthroscopy (for arthritis and ankle injuries): This minimally invasive surgery involves several small incisions in your ankle. There are some potential risks of surgery that are specific to the lateral ligament reconstruction procedure. Your surgeon may then reattach these ligaments to your fibula by using small new holes drilled into your bone. Good luck to you and your son. Will try to inform about my progress here.. the general timeframe the docs gave me are; Buy it. So theres a shopping list of things you need to prepare for. Fair to say Im stressing as I have Brostrom procedure coming up in 3 weeks time- after 7 years of not being able to walk on my ankle properly!! Going to see the surgeon next week but we know he will definitely need surgery. I did my best to improve my balance with my eyes shut while washing my teeth, but there didnt seem to be much more that I could do; except be careful. Goals of surgery are to reestablish ankle stability and function without compromising motion and without complications. endobj The repaired ligament is often strong and creates increased stability of the ankle. 3727 Buchanan St #300 Get useful, helpful and relevant health + wellness information. The ligaments in the ankle include: anterior tibiofibular ligament, lateral collateral ligament, deltoid ligaments. [emailprotected] Foot Ankle Int. For more details about recovering from ankle ligament reconstruction surgery, read our downloadable patient information leaflet. But I was young then and I figured I had nothing to worry about. My physical therapist was not amused. Are there any other elite athletes whove had this experience and did you get back to what you love and how long did it take? Lets dig in. Progress to full weight bearing in walking boot. A damning indictment on the state of over-charging in American healthcare. Lateral ankle instability can be treated surgically, either with tightening of the existing ligaments (anatomic repair, example: Brostrom procedure) or a lateral ankle ligament reconstruction using a tendon graft (See Figure #1). You can set your browser to block or alert you about these cookies, but some parts of the site may not work then. Wear a lace-up ankle support for athletics. It is important to stick to nonsurgical treatments to deal with chronic pain. The nerve is usually identified and is not normally cut but retracted away from harm. Drilling holes in bones and lacing your tendon to create a new ligament does not ensure that your ankle will be stable, Surgery is associated with complications which include injection, failure, nerve damage, and ligament laxity, Ankle ligament surgery involves significant pain, recovery, and rehabilitation. This evidence-based guideline is criterion-based; time Been told pre-op that the cast will stay for 2 weeks, but post-op they told me 3 weeks, cast removal and boot phase set for February 12. An ankle-ligament reconstruction weaves a harvested tendon graft, most commonly the peroneus brevis, to augment the lateral ligaments of the ankle. The incidence of ankle sprains is between two and seven per 1,000 people and ankle sprains account for approximately 30% of all sports-related injuries (1). Ankle problems that may need surgery include: Surgeries can range from minimally invasive arthroscopy to ankle replacement surgery. Careful observation and ongoing assessments will dictate progress. Ok. The short answer is yes as the damaged ligaments are removed, holes are drilled into the bones and tendons are harvested from different body sites. The most common type of ankle sprain is an inversion injury, or lateral ankle sprain. Currently in San Francisco, CA | 1.415.342.1350 |, NHS (Royal Berkshire) Guide to Brostrom Repair, NHS (Guys & Thomas) Guide to Brostrom Repair. The procedure is challenging and can not be performed by your PCP or orthopedic surgeon. Risks for this surgery include: Your own risk for complications depends on your age, the anatomy of your foot, and your general health. On the left, the red circle identifies the anterior talofibular ligament (ATF) which is loose and is bowing in nature. Patients undergoing this type of surgery typically need a 6-week period where the ligaments are allowed to heal. Since Id had surgery on my right foot, I was told I couldnt drive for six weeks. Your foot and ankle have several ligaments. The foot rolls inward, damaging the ligaments of the outer ankle the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament. New masking guidelines are in effect starting April 24. The yellow circle identifies the complete healing of the ATF ligament after the PAL treatment. Lateral ankle ligament reconstruction is a surgery to tighten and firm up one or more ankle ligaments on the outside of your ankle. 269 Chestnut St. #271 Is anyone experiencing tightness or pain arcing from outside ankle bone to interior ankle bone? A study published in 2017 looked at the outcomes of 669 Brostrom procedures and found the need for a second operation was only 1.2% on average 8.4 years after their Brostrom procedures. Compression socks from different countries started to pile up in my drawers. I just lay there on the trail for hours until some friends and the park ranger hiked in with my old crutches. The doctor knew right away from pulling my ankle out at a funny angle, and the MRI confirmed: Two of my ligaments, the ATFL and CFL were completely torn. Ligaments are the thick connective bands of connective tissue that connect one bone to bone. Seeing is believing. Yes Ive just had this done 3 days ago 2 weeks in an open cast then 4 weeks in boot . In one study the complication rate was 29% and involved wound healing, nerve injuries, blood clots, complex regional pain syndrome (3). Vaccines & Boosters | Testing | Visitor Guidelines | Coronavirus. Cold Therapy To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48-96 hours and then as needed to help control pain and swelling. Certain mechanical problems with your foot can make you more likely to develop an unstable ankle, such as: You may have already been treated with physical therapy and special foot inserts. Ankle inversion Sprain/Ligament rupture Questions and advice. Sometimes, an injury can cause these ligaments to tear and that is when you have to consider undergoing ankle ligament surgery. Ways to get in touch. Full passive/active range of motion by end of 12 weeks. The goal is to repair the loose lateral ligaments. I just had surgery on 1/09/23. time, was adapted from the protocol used at the Hospital for Special Surgery (HSS), where the modified Brostrom-Gould procedure is the preferred anatomical surgical procedure for the . Ligaments are the thick connective bands of connective tissue that connect one bone to bone. You should have someone drive you home. Hold off on scar mobilizations x 4 weeks or per MD. . If, like many of our patients, you don't live in the Bay Area, we offer a complimentaryphone consultation service. Non weight bearing for 3 weeks--no push off or toe-touch walking. We are so concerned that his soccer aspirations may be over (well they are for the season but concerned for long term). I started re-twisting my ankle again on stupid things, so I went back to the doctor fearing all had been undone. Pain would shoot out as I started to put partial weight on the foot while walking in crutches. You will need to return in about 10 days after your surgery to have your stitches or staples removed. Progress from boot to aircast at 8 weeks post operatively. Our specialisms cover knee, foot & ankle, spine, shoulder, elbow, hand & wrist, hip & groin, chest & ribs, podiatry and pain conditions. Buses would wait for me, people would hold open doors, carry my food, strike up random conversations. The names of each ligament refer to the bones they attach to. Ankle instability has been referred to as either functional instability or mechanical instability. Described by Dr. Stone as a "gift to his patients," this short, weekly blog focuses on sports, performance, & orthopaedic care. Friends came to visit, and I took them to Yosemite. I was on the table for an MRI but my referral was incorrectly written. Its not common to need this surgery right after a first ankle sprain. Often, lateral ankle ligament reconstruction is an outpatient procedure. Youll need to use this brace for several months. Forefoot surgery has the advantage that most patients can walk on their heels. After surgery, your ankle is bandaged and placed in a splint. See if you're a Candidate for Regenexx Procedures. The purpose of the Brostrom-Gould procedure is to stabilize the ankle ligaments, improve the ankle's mechanics and restore full function. Arthritis that causes pain and immobility. Often an ankle arthroscopy is performed in conjunction with a lateral ligament reconstruction. I had a similarly damaged ankle and found an orthopedic dr who works on lots of athletes. scar mobilization) to decrease fibrosis. With each sprain, the corners of the bone starts to grind into the cartilage. Clinical Instability of the Modified Brostrom Evans Procedure to Restore Ankle Instability. Caution with talocrural and subtalar mobilization. Recovery Patients undergoing this type of surgery typically need a 6-week period where the ligaments are allowed to heal. Doctor says this is completely to be expected at this stage. They didnt really add much support. Brostrom ankle surgery is a reconstruction of one or more lateral ankle ligaments. Brostrom ankle surgery is a reconstruction of one or more lateral ankle ligaments. x\o8"aE""@vP p{PdUq\IN/%YvY/kG4Co>g7Xpuf?Bd3dZHVgS0!xL !!SZ$f_-jx([_qO?gdpqQ7b'iD Below are ankle MRIs before and after bone marrow concentrate treatment at our clinic. Soon I found myself able to walk up stairs, then down stairs. What are the risks of this Brostrom procedure? Any others with experience like this?! Apparently its important to get ahead of the pain. The reason you are having the test or procedure, What results to expect and what they mean, The risks and benefits of the test or procedure, What the possible side effects or complications are, When and where you are to have the test or procedure, Who will do the test or procedure and what that persons qualifications are, What would happen if you did not have the test or procedure, Any alternative tests or procedures to think about, Who to call after the test or procedure if you have questions or problems, How much will you have to pay for the test or procedure. 5.Yasui Y, Murawski CD, Wollstein A, Kennedy JG. So it felt great being able to put my running shoes on and go explore new places. Please contact us for advice if you are worried about any aspect of your health or recovery. This website uses Google Analytics to collect anonymous information such as the number of visitors to the site, and the most popular pages. Gradually increase intensity of exercises focusing on closed-chain and balance / proprioception. %PDF-1.5 This is more likely if you did not have the first sprain treated properly. I started regularly running again and loved it. stream <> The total expected recovery time is 6-12 months. Ankle surgery may cause complications, including: Immediately after your procedure, your ankle is immobilized (kept from moving) for several weeks. Keep the postoperative dressing dry. 4 weeks boot I was participating in indoor cycling classes and walking and running without pain or issues. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://orthoinfo.aaos.org/en/diseases--conditions/ankle-fractures-broken-ankle/), (https://www.footcaremd.org/conditions-treatments/ankle/ankle-fracture-surgery), (https://www.arthritis.org/health-wellness/treatment/joint-surgery/preplanning/surgery-options-for-ankle-arthritis). I had a modified Brostrom, superficial deltoid reconstruction, repair of talas dome lesion and destroyed cartilage, and extensive debridement. 1987;7(6):362-8. He told me to use my crutches with my boot for 3 days, then discard my crutches. Surprisingly, severe pain didnt come. I managed to walk the Vernal Falls circuit partially weight bearing with the underarm crutches, up slippy rocks, and through snow. [1] Purpose The purpose of this procedure is to stabilize the ankle, improve the ankle's mechanics and restore full function. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); In January 2018, I had ankle surgery to repair torn ligaments. In the repair and healing process, this nerve can become scarred, leading to either decreased sensation over the top of the foot or in some cases, a painful burning sensation in this region. Avoid plantar flexion greater than resting position for 4 weeks. The Brostrom ankle stabilization surgery is a very good and reliable surgery for stabilizing a chronically weak ankle. To watch an ultrasound-guided ankle injection please clinic on the video below. During this time, patients are either non weight-bearing or putting only limited weight through the operated extremity. Learn about procedures that can help you return to sports & delay or avoid ankle fusion/replacement. Back when I was in boy scouts, our scout troop leader had a limp. By this point the physio laughed at me, and said there was nothing she could really do. Advertising on our site helps support our mission. 33 yeard old, football injury that never headled. "Z%I~FD&LR5 ,uuodu^ncz~ecV6[>x4Okk/ 3/_7g/1n|yx a.s(vy|y1?E9_?|/lzb,r~x\xnOU[R\_JZ"R:jWWM2oN)JiY;%~GoHqE~+>;'q:. Then there were a few good sprains that put me out of running for months. Surgical complications include bleeding, infection, nerve damage, and surgical failure. Many patients can return to work five to six weeks after their operation, even in cases where their job involves manual work or walking. Over time, straight-line running will be allowed. I couldn't get a follow up with the surgeon, instead seeing a consultant. You should experience minimal scarring and go home on the day of surgery. The next couple days, its best to remain in bed, and believe me, I had no desire to be up and about. My disabled parking placard came. The ankle started to ache not badly, but noticeable. 2006;11(3):659-62. I was given paracetamol and codeine and told to take ibuprofen if I needed from 48hrs after the surgery. Your surgeon may remove your ATFL and your CFL ankle ligaments from where they attach on your fibula. Before your procedure, you may need imaging tests, such as X-rays or an MRI. Another important complication is recurrent instability (4) which puts the ankle at risk for additional injury, degeneration, and arthritis. It's also known as the Brostrom procedure. They sent me home with prescriptions for lots of ibuprofen and opioids (oxycodone). Effleurage, gentle soft tissue mobilization to ankle avoiding incisions. Complications from surgery are most commonly encountered during the rehabilitation phase. Well-leg cycling, well body weight training. In fact I felt fine like Id just taken a morning nap. The ATFL is the most frequently injured ligament, followed by the CFL and . If revision of a Brostrom repair is required many surgeons will choose to perform a, Did you know our resouces can be found in. These are commonly injured when the ankle is sprained and on occasions will lead to symptomatic instability needing surgery. endobj He also has a small talus fracture. Recovery from ankle ligament surgery requires wearing a cast or splint for a minimum of two weeks, and in this initial period it is crucial to rest your ankle as much as you can. You might need ankle ligament reconstruction surgery if you are suffering from an ankle sprain or instability. He is also the official US rugby team Dr and works with elite level soccer and rugby players. Dot , Hi Dot, how are you doing after your surgery? This surgery is often referred to as a Brostrom ligament operation. Running a couple times a week now, without any noticeable problems from the surgery. Youll want to shower. The first line of defense in managing post-operative pain after Brostrom surgery is medication. Ankle Sore After Walking? Policy. I stopped hiking; it also wasnt worth the risk. John R. Schultz M.D. Frequently, this procedure is performed once other non-surgical treatments, including physiotherapy, have proved ineffective. So, with insurance in hand, I went to get some long overdue physical therapy. Six months: Your ankle will be recovered from surgery by six months. 8.Centeno C, Markle J, Dodson E, et al. 1 0 obj Other risks include infection, wound healing problems, and nerve injury. This usually entails wrapping your ankle in a plastic garbage bag to keep it dry. Fortunately, alarge number of ankle ligament injuries are only partial-thicknessor full-thickness tears without retractions. Brostrom-Gould Reconstruction restores ankle stability by repairing the lateral (outside) ligaments of the ankle. He lamented to us often about the importance of good boots. It usually takes about 6 weeks to recover from your surgery. Keeping your leg elevated may help reduce swelling and pain, too. Yes this is exactly what happens to me as well but nobody really understands my explanation of the pain I get. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Nerve block stopped influencing during the day, I got some weak opioids and Ibuprofen. Keep 2 inch no touch zone around portals x 4 weeks. %PDF-1.7 But the boot came off, and it was soon time for physical therapy! Ankle surgery is not for the faint of heart. I go in about 2 weeks for the MRI. It took a while to get to 100%, but it was well worth doing! Recovery times vary depending on the surgery. Surgery on an ankle may be needed to treat fracture (broken bone), arthritis, tendonitis and problems that cant be resolved with therapy and medications. Initiate gentle dorsiflexion- slow progression to full range of motion. Im gross it will be painful when I start Pt. Damage to nerves or blood vessels in the ankle. Before you are discharged from hospital, you will be given crutches and shown how to use them to help you walk. 3 weeks cast Injuries occur from trauma such a rolling your ankle. Your healthcare provider will give you specific instructions about how to strengthen your ankle and leg muscles as you recover. Inversion sprains are the most common types of sprain where the foot bends outwards. Ask if you should stop taking any medicines ahead of time, like blood thinners. After a couple days in bed, I was ready to get up and move around. The foot was bruised, tingly and uncomfortable. This program focuses on: For a number of months after surgery, the repair is often protected with anankle laceror equivalent. This is often confirmed on x-rays with a stress view. The pain that originates from other sources such as the ankle joint itself will not necessarily be addressed with this procedure. Right. Regular soft tissue treatments (i.e. The years passed by, the sprains kept coming. If this type of neuritis occurs, fairly aggressive therapy to desensitize this area is required. Its also known as the Brostrom procedure. The Brostrom procedure is performed to addressankle instabilityand not pain. After surgery, most people return to their normal activities within six to eight weeks. No running, jumping, or ballistic activities for 6 months. Initiate stationary cycling, no clip ins, light to no resistance, and slow cadence. They may not take you as a good candidate for surgery if you have nerve or collagen disease. Alternatively, the repair may require strengthening using support from other tissues, or a tendon may be used to take the place of torn ligaments. 7.Centeno CJ, Pitts J, Al-Sayegh H, Freeman MD. Careful observation and ongoing assessments will dictate progress. Office hours: 7am 5pm. I had my surgery done with Daniel Thuillier at UCSF. Reasons to avoid Brostrom ankle surgery include. Inversion sprains are the most common types of sprain where the foot bends outwards. Stem cells can heal ligament tears in two principal ways (6). The big ones stick in my mind; sprains while hiking down from overnight camping trips, trips while trail running, trips while out for a morning run. Posterior splint immobilizer for 3 weeks. Recruit other repair cells in the body to come and assist. Recovery times vary depending on the surgery. Following a Brostrom repair, the following post-operative changes are considered "normal" and are frequently observed: Loss of inversion ROM up to 15 degrees Ankle eversion strength deficit of 10% or greater Decreased balance, with increased postural sway Decreased proprioception Disclaimer It may be that the existing ligament can be repaired using stitches. And then, on a gorgeous morning in the Marin headlands, my foot landed funky on a rock. There are three ligaments that are designed to keep things in place, but repeated injuries will weaken and eventually tear these completely. Carefully monitor the incisions and surrounding structures for mobility and signs of scar tissue formation. Isometrics in multiple planes and progress to active exercises in protected ranges. I was soon on an exercise bike every other day, and 30mins on the bike seemed to leave me a little more mobile than before. You do need to be very cautious as you get started, and you do want to keep that right foot out of the way. My arms grew strong. We do not endorse non-Cleveland Clinic products or services. Cycling with boot, aerobic machines in splint as tolerated, and pool workouts in splint once incisions closed. It also helps protect it from further damage or injury. This first sprain makes it more likely that you will sprain your ankle again. cookielawinfo-checkbox-non-necessary. Then your surgeon tightens one or more of the ligaments on the outside of your foot. Dont use the underarm crutches. Foot Ankle. What is Brostrom ankle surgery? Very odd Mine was two weeks in a cast, then two weeks in boot (none weight bearing, at four weeks 50% weight bearing for two weeks then full weight bearing at 6 weeks in the boot. Hi all. My foot feels strong and stable. On the outer side of your foot, you have several ligaments. Knee Hurts When I Bend It and Straighten It, Burning Pain on Outside of Knee When Kneeling, Muscle Pain After Cervical Fusion Surgery, Basal Joint Arthritis or CMC / Carpometacarpal Arthritis, Common Craniocervical Instability Symptoms, Perc-FSU Trusted Alternative to Spinal Fusion, Perc-ACLR - Regenexx Treatment for ACL Tear, Regenexx Non-Surgical Alternative to Cervical Fusion, Perc-CT SR Alternative to Carpal Tunnel Surgery, Non-surgical Disc Bulge or Herniated Disc Treatment, Regenexx Alternative to Ankle Fusion Surgery, Perc-CMC Alternative to CMC Joint Surgery, Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy, Operative treatment of lateral ligament instability, Arthroscopic repair of chronic lateral ankle instability, Outcome of the modified Brostrm procedure for chronic lateral ankle instability using suture anchors, Reconstruction of the lateral ligamentous structures of the ankle with a modified Watson-Jones procedure, Reoperation rates following ankle ligament procedures performed with and without concomitant arthroscopic procedures, Ligament and tendon repair through regeneration using mesenchymal stem cells, https://www.ncbi.nlm.nih.gov/pubmed/25274564, Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series, Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. It can cause chronic pain, repeated ankle sprains, and an ankle that often gives way when you walk or perform activities. San Francisco CA 94123, tendon reconstruction of the lateral ligaments, Continued Symptoms / Failure to resolve all of the symptoms. As a result, up to 40% of patients with lateral ankle sprains suffer from chronic ankle instability (CAI). Im still hopeful for a full recovery, although a little fearful that my running days are over. They kicked me out of the hospital soon after, and I rode home to enjoy two weeks under house arrest. Modifications to this guideline may be necessary dependent on physician specific instruction, degree of the tear, specific tissue healing timeline, chronicity of injury and other contributing impairments that need to be addressed. So I signed myself up for the basic dose before I went to sleep and braced myself for the pain to come. You might need this surgery if one or more of the ligaments on the outside of your ankle has loosened or stretched. endobj You have a doctor's appointment 10 to 14 days after your surgery. If your surgery is minimally invasive, your surgeon will cut a small incision. It was left foot or nothing, and the left foot rose to the challenge. I rolled my left ankle and broke it walking to the car. Modified Brostrom procedure. I was in a cast for 6 weeks, non weight baring. The anterior talofibular ligament is tightened. Damaged ligaments can lead to ankle instability which if left untreated is a BIG deal. Ask your healthcare provider about the details of your surgery.

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