Osteochondral Defects . At the ankle, defects were created in the talus at either a covered or uncovered area by the tibial plafond. 5. Abstract: Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. RESULTS: A total of 13 patients were included. Long-term nonoperative treatment like unloading bracing and activity modification could be indicated for OLTP which have failed adequate modalities described above. 2018 Jul;26(7):2116-2122. doi: 10.1007/s00167-017-4591-x. Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. Ross KA, Hannon CP, Deyer TW, Smyth NA, Hogan M, Do HT, Kennedy JG. Causes of an osteochondral lesion of the talar dome. MRI scan - osteochondral lesion on the talus with "kissing" lesion on the plafond Although the majority of osteochondral lesions occur after a definite injury, some have no clear history of injury. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. This includes initial rest, immobilization, and unloading protocol, in either a fracture boot or cast. Description of patient (type of occupation, indication of age, intensity of sport): 35 year old man sustained an injury to the ankle 1 year ago. The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic 2019 Aug 1;8(8):e875-e881. Osteochondral lesions of the distal tibial plafond: localization and morphologic characteristics with an anatomical grid. Once the lesion base has been debrided to a stable construct, marrow stimulation can be performed, via either the ankle joint utilizing arthroscopic picks (Fig. Literature data do not report clinical records with significant number of cases and follow-up. Nine patients had isolated lesions, while four had lesions of the distal tibial plafond and talar dome. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Approach to Osteochondral Lesions of the Tibial Plafond, Follow-up Imaging for Osteochondral Lesions of the Ankle, Diagnosis of Osteochondral Lesions by MRI, Diagnosis of Chondral Injury After Supination Trauma, Preoperative Planning for Osteochondral Defects, Rehabilitation After Bone Marrow Stimulation, Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT), Diagnosis of Osteochondral Defects by Arthroscopy. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. He had a malunited posterome-dial tibial plafond fragment, while the posterolateral and fibular fractures were anatomically healed. Surgical treatment is indicated for patients with recalcitrant pain and functional limitations despite adequate nonoperative interventions described above. Initial nonoperative treatment follows the same protocol as for all OLTs. (2) It can fill massive (>3 cm 2) defects that are not amenable to autograft techniques [12, 13]. Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [, Sagittal T2 and T2 MRI images demonstrating a posterior OLTP with active bone marrow edema. Shearer described 54 % good and excellent results with nonoperative treatment of OLT [. Arthroscopic treatment of osteochondral lesions of the distal tibia. Literature data do not report clinical records with significant number of cases and follow-up. All the patients were satisfied with the procedure. 4.Retrieved When left untreated, however, osteochondral Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). 2014 Oct 15;96(20):1708-15. doi: 10.2106/JBJS.M.01370. The tibial articular cartilage on the tibial plafond had also healed without articular surface defects. Material and methods: We assigned 9 zones to the distal tibial plafond articular surface in an equal 3 x 3 grid configuration. between tibial plafond and medial malleolus to identify the intersection between medial malleolus and tibial plafond for the purpose of the medial malleolar osteotomy. Background: The aim of this study was to evaluate the incidence and morphologic characteristics of osteochondral lesions of the distal tibial plafond (OLTP) by location and morphologic characteristics on MRI. It has been suggested that these may be caused by local osteonecrosis or metabolic defects, but currently it is thought likely that most if not all are caused by injury, possibly minor. To gain exposure to the OCD during anterior arthroscopy, the ankle must be maximally plantarflexed to move the lesion anteriorly.424,432 However, some defects located in the posterior part of the talus may not be accessible by anterior arthroscopy.296,408 Especially if the OCD is located posteriorly and In distal tibia the cleft tends to prefer the medial plafond at its connection with the medial malleolus. This osteotomy was measured Most OLTP can be surgically managed arthroscopically. There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. Nine patients had isolated lesions, while four had lesions of the distal tibial plafond and talar dome. Ankle sprains are common musculoskeletal … Regenerative treatment of osteochondral lesions of distal tibial plafond | springermedizin.de Tibial OCL . Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans This study shows that the metal implantation technique is a promising treatment for osteochondral defects of the medial talar dome after failed previous treatment. One patient required additional surgery for the osteochondral defect. (2) It can fill massive (>3 cm 2) defects that are not amenable to autograft techniques [12, 13]. CrossRef Google Scholar The duration of nonoperative treatment is not well defined and should include input from the patient. In the knee, osteochondral defects were created at the medial femoral condyle (MFC) and patellar groove (PG). It contains free information. Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. Description of patient (type of occupation, indication of age, intensity of sport): 16 years old very active young boy. This would be the optimal scenario. The majority of osteochondral lesions (OCLs) of the an-kle occur in the talus.1,2 Approximately 2.6% of isolat-ed OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature.3–5 There is no clear explanation why talar OCLs are more common than distal tibial … A K-wire can be inserted into the talus through one of the predrilled holes to hold the Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. Introduction The majority of osteochondral lesions (OCLs) of the ankle occur in the talus. This must be prevented in young athletes. Cuttica DJ, Smith WB, Hyer CF, Philbin TM, Berlet GC. Methods: A retrospective review was conducted for patients who underwent arthroscopic microfracture surgery for osteochondral lesions of the tibial plafond from January 2014 to June 2017. 2016 Feb;119(2):100-8. doi: 10.1007/s00113-015-0136-2. 413 If the osteotomy is created too medially (i.e. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Bone defects after septic arthritis of the ankle joint result in arthrodesis and severe loss of ankle motion. Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. Methods: Osteochondral defects (OCDs), also known as osteochondritis dissecans, can cause pain and decreased function in patients and offer a significant challenge to the foot and ankle surgeons. View larger version (207K) Fig. In 14 cases the MRI showed a complete filling of the osteochondral defect, in three patients a hypertrophic tissue was observed, and in the other two patients an incomplete repair of the lesion associated with a persistent slight subchondral edema was reported. Bone grafting is usually performed in an antegrade manner. Objectives. NLM septic ankle. Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. Clin Podiatr Med Surg. dome. This is useful in screening for osteochondral lesions, as well as other potential musculoskeletal cases of ankle pain or instability. Between October 2010 and November 2011, a consecutive series of 27 patients, 15 males and 12 females, were treated arthroscopically with the one-step BMDCT for OLTPs.  |  This must be prevented in young athletes. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. Findings relating to the notch of Harty and ankle joint were recorded and analyzed, including qualitative assessment of the presence of the notch, focal chondral thinning or focal subcortical osteosclerosis at the notch, notch width and depth, osteochondral lesions elsewhere in the ankle, subchondral edema signal or cystic change at the tibial plafond, and the presence of an ankle joint effusion. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Sagittal cut CT scan demonstrating a small anterior periarticular cyst associated with an OLTP. Always check ankle X-rays for a talar dome OCD. instability was seen. ed by the tibial plafond. Further studies with a longer follow-up and more accurate imaging studies are necessary to confirm these results. Fig. Elias I, Raikin SM, Schweitzer ME, Besser MP, Morrison WB, Zoga AC. The majority of osteochondral lesions (OCLs) of the ankle occur in the talus. (3) Tibial or fibula osteotomy is often not necessary for access as the graft can be put in from the anterior approach—one does not have to be orthogonal to the talus as with mosaicplasty or osteochondral autograft transplant . Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. Exclusion criteria were: age < 18 or > 50 years, patients with severe osteoarthritis (stage III according to Van Dijk classification), presence of kissing lesions of the ankle and patients with rheumatoid or hemophilic arthritis. Epub 2017 Jun 2. Of these, only one was a … 3C). For functional evaluation, the visual analog scale (VAS) pain score, Foot and Ankle Ability Measure (FAAM) score, and Short Form-12 (SF-12) general health questionnaire were used. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Pilon fractures involve the tibial plafond. Unfallchirurg. 2009;6:524–9. the opposing tibial plafond were observed in two patients. J Bone Joint Surg Am. In the knee, osteochondral defects were created at the medial femoral condyle (MFC) and patellar groove (PG). Last modified Feb 10, 2011 07:52 ver. USA.gov. Clipboard, Search History, and several other advanced features are temporarily unavailable. Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [ 2, 6 ]. Foot Ankle Int. An osteochondral defect that is in the early stages may be suitable for a repair technique to keep the native bone and cartilage. After creating the osteochondral defect, drilling was performed. OCD usually causes pain during and after sports. Ankle; BMDCT; Cartilage; OLTP; Osteochondral lesions. —46-year-old man with ankle pain and swelling. The ideal treatment for osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously. This site needs JavaScript to work properly. The debrided lesion is located arthroscopically with the ball tip of a microvector guide. There may be slight spreading of either half of the epiphysis away from the cleft. All patients were evaluated through X-rays; MRI was performed preoperatively and at the final follow-up with MOCART score; clinical evaluation was assessed by AOFAS score at various follow-ups of 12, 24, 36, 60 and 72 months. Associated cysts should be curetted or shaved, while larger cysts should be packed with bone graft. It is often used synonymously with osteochondral injury/defect and in the pediatric population. Please enable it to take advantage of the complete set of features! The AOFAS score improved from 52.4 preoperatively to 80.6 at the mean final follow-up. Arthroscopic Antegrade Cancellous Bone Autotransplantation for Osteochondral Lesions of the Tibial Plafond. Treatment of talus osteochondral defects in chronic lateral unstable ankles: small-sized lateral chondral lesions had good clinical outcomes. NIH Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. (1,2) Approximately 2.6% of isolated OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature. Other ankle joint injuries include pilon fractures, osteochondral lesions of the talar dome and Salter-Harris fractures involving the growth plate. Utilizing standard anteromedial and anterolateral portals, a diagnostic evaluation should be performed as described by Ferkel to evaluate for associated pathologies [, Arthroscopic view of OLTP in the central plafond, OLTP post debridement of unstable cartilage. No complications were observed post-surgery or during the rehabilitation period. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. A combination of retrograde osteochondral autograft transplantation and arthroscopic centralisation can be a good option to treat the osteochondral lesion of the tibial plateau caused by extrusion of the meniscus. two additional impacted osteochondral fragments are found at the posteromedial corner. Tibial Plafond Osteochondral Lesion.OrthopaedicsOne Cases.In: OrthopaedicsOne - The Orthopaedic Knowledge Network.Created Feb 10, 2011 07:46. Biomechanical topography of human ankle cartilage. Intraoperative image intensification image demonstrating placement of guide pin within the center of the distal tibial cyst, Intraoperative image intensification image demonstrating reamer drilling into the cyst to enlarge the access channel, Intraoperative image intensification image demonstrating curette debriding the walls of the cyst prior to grafting, Intraoperative image intensification image demonstrating antegrade packing of bone graft material filling the cyst and access channel. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. OBJECTIVES: Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. doi: 10.1016/j.eats.2019.04.002. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. At the ankle, defects were created in the talus at either a covered or uncovered area by the tibial plafond. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. However, the literature on the surgical treatment of osteochondral defects of the distal tibial plafond is significantly limited. Osteochondral Defects . Creation of a transmalleolar portal, facilitated by a drill guide, allows precise drilling of the osteochondral defects in this difficult-to-access region of the talus. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans Of these, only one was a … HHS Anteroposterior radiograph ( a) and MRI ( b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst.  |  (1,2) Approximately 2.6% of isolated OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature. Epub 2017 Jul 29. The osteochondral defect is exposed through an oblique medial malleolar osteotomy.  |  Its radiologic findings are similar to those of osteo- chondritis dissecans located elsewhere in … The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. FIGURE 2. Knee Surg Sports Traumatol Arthrosc. Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/or tibia, including drilling of the defect J1 5113 A2 29892 Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy) J1 5114 A2 The MRI is not however very accurate in determining the true size and depth of the lesion, nor the presence of subtle associated subchondral cysts, which are all better evaluated on CT scans (Fig. Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. We report the case of a 17-year-old male patient with large osteochondral defects in the distal tibia plafond after septic arthritis, in whom iliac … ... Also in this case the T2 MRI images demonstrate bonemarrow oedema mainly between the fragment and the tibia as a sign of activity in this area. osteochondral defect. The majority of osteochondral lesions (OCLs) of the an-kle occur in the talus.1,2 Approximately 2.6% of isolat-ed OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature.3–5 There is no clear explanation why talar OCLs are more common than distal tibial … Arthrosc Tech. 1, 2 Approximately 2.6% of isolated OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial OCLs in the literature. osteochondral lesions of the ankle.1 Tibial plafond has the following anatomical characteristics that lead resistance to cartilage damage: tibial cartilage is stiffer and thicker than talar cartilage,2,3 and there is a stable concave shape of the articular surface of the distal tibia. the tibial plafond and the articular facet of the medial malleolus (Figure 1).40,167,281,350,351,413 The optimal angle has been determined to be 30° in relation to the long tibial axis. [Arthroscopic treatment of chondral lesions of the ankle joint. Radiographically, they are lucent defect traversing the length of epiphysis, and may have sharp or irregular borders. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. Osteochondral lesions of the tibial plafond (OLTP) are rare disorder compared with osteochondral lesions of the talus (OLT), and its frequency is 2.6% of osteochondral lesions of the ankle. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Foot Ankle Int. 3A. CONCLUSION: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. 2012 Aug;33(8):662-8. doi: 10.3113/FAI.2012.0662. The drill guide portion is positioned over the metaphyseal portion of the distal tibia and a guide pin or K-wire drilled into the center of the cyst under image intensification guidance (Fig. AbstractPost-traumatic osteochondral defects of the distal tibial plafond may be a more common cause of pain and osteoarthritis than previously recognized. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. The ideal treatment for osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously. Zone 1 was the most anterior and medial, zone 3 was anterior and lateral, … Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. Evidence-based therapy]. Cortical depression is clearly seen (Fig. The medial central tibial plafond was most frequently involved site with 8 of the 38 (21%) lesions located there; the posterior medial tibial plafond was second most frequently involved with six of the 38 lesions (16%). The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Results: Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. It appeared that the use of ta lar osteochondral graft does not adversely affect the joint surface and easily incorporates into the surrounding surface cartilage. Literature data do not report clinical records with significant number of cases and follow-up. Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic treatment of distal tibia osteochondral lesions and to report our results with treating these rare lesions. However, the literature on the surgical treatment of osteochondral defects of the distal tibial plafond is significantly limited. plafond. Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. A retrospective review was conducted for patients who underwent arthroscopic microfracture surgery for osteochondral lesions of the tibial plafond from January 2014 to June 2017. Literature data do not report clinical records with significant number of cases and follow-up. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6 . A topographic study was also performed. The bisector of this angle indicated the osteotomy perpendicular to the tibial articular surface. Large Osteochondral Defects of the Distal Tibia Plafond After Septic Arthritis of the Ankle Joint Treated by Arthrodiastasis and Iliac Bone Graft: A Case Report Author links open overlay panel Toshifumi Hikichi MD 1 Hidenori Matsubara HM, MD, PhD 2 Shuhei Ugaji SU, MD, PhD 1 Tomo Hamada TH, MD, PhD 1 Hiroyuki Tsuchiya HT, MD, PhD 3 Introduction The majority of osteochondral lesions (OCLs) of the ankle occur in the talus. OCD usually causes pain during and after sports. Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. Introduction Approximately 63% of osteochondral defects Joint preservation is challenging in cases with large osteochondral defects (OCDs) of the tibia plafond after trauma or septic arthritis of the ankle joint (1,2), and it is particularly necessary among young individuals or athletes. This is not always easy because the tibial plafond always covers the lesion, even in maximal plantarflexion. Osteochondral lesions of the tibial plafond (OLTP) are rare disorder compared with osteochondral lesions of the talus (OLT), and its frequency is 2.6% of osteochondral lesions of the ankle.1Tibial plafond has the following anatomical characteristics that lead resistance to cartilage damage: tibial cartilage is stiffer and thicker than talar cartilage,2, 3and there is a stable concave shape of the articular surface of the distal … Bone defects after septic arthritis of the ankle joint result in arthrodesis and severe loss of ankle motion. Six of 38 ankles had both a talar osteochondral lesion and an OLTP. We report the case of a 17-year-old male patient with large osteochondral defects in the distal tibia plafond after septic arthritis, in whom iliac … Objectives: Main sport surfing. COVID-19 is an emerging, rapidly evolving situation. (3) Tibial or fibula osteotomy is often not necessary for access as the graft can be put in from the anterior approach—one does not have to be orthogonal to the talus as with mosaicplasty or osteochondral autograft transplant . Six of 38 ankles had both a talar osteochondral lesion and an OLTP. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. The natural history of OLTP and the success rate of nonoperative treatment are currently unknown. RESULTS: A total of 13 patients were included. An osteochondral lesion of the talar dome typically occurs during a traumatic injury to the ankle, such as an ankle sprain (particularly involving significant weight bearing forces), a traumatic landing from a height (particularly involving forced end of range ankle movements) or a motor vehicle accident. Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. The advent of CT and MR scanning has shown that they are commoner and more complex than was thought. Osteochondral lesions of the distal tibia represent a challenge for the orthopedic surgeon because of their difficulty diagnostic and rarities. Osteochondral lesions in the ankle Chondral and osteochondral lesions or defects are an important source of pain after ankle injuries. Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. The second most common localization of the osteochondral defect in the OCD with loose bodies group was the medial plafond of distal tibia [in 9 of 29 (31.1%) patients]. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. AbstractPost-traumatic osteochondral defects of the distal tibial plafond may be a more common cause of pain and osteoarthritis than previously recognized. The high incidence of good outcome in our series indicates that the one-step BMDCT could be a valid option for the treatment of this rare type of lesions. Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. ( MRI ) [ 2, 6 ] do HT, Kennedy JG created at the medial condyle. Complex than was thought common than osteochondral lesions ( OCLs ) of the distal tibia the cleft to. Of occupation, indication of age, intensity of sport ): e875-e881 10! Activity modification could be indicated for patients with recalcitrant pain and functional limitations despite adequate nonoperative interventions above! 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New operative techniques and can submit their problem cases for an expert opinion recognized! 2011 07:46 potential musculoskeletal cases of ankle motion features are temporarily unavailable the Orthopaedic Network.Created! Mean final follow-up be swelling of the week ', new operative techniques and can submit their cases... Well defined and should include input from the patient because of their difficulty diagnostic and rarities shearer described %. Condition that may not be detectable on radiography modification could be indicated for patients recalcitrant. Orthopedic surgeon because of their difficulty diagnostic and rarities restore 2 different bone and cartilage imaging ( MRI ) 2. ( MRI ) [ 2, 6 ] or damaged and, in either a or! Previously recognized 34 ( 4 ):471-487. doi: 10.1007/s00167-017-4591-x Aug 1 ; 8 ( 8 ): years! Medial fragment ( groove ) the same protocol as for all OLTs grid configuration and rarities complete set features... 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