Tommy John – The Surgery

Tommy John surgery repairs an injured elbow ligament. It’s most commonly done on college and pro athletes, especially baseball pitchers. But it’s sometimes done on younger people as well.

Tommy John surgery is also called UCL reconstruction. UCL is short for ulnar collateral ligament. During Tommy John surgery, a surgeon replaces the injured UCL with a tendon taken from somewhere else in the patient’s body.

The UCL is located on the inside of the elbow. It connects the bone of the upper arm (humerus) to a bone in the forearm (ulna). Anyone can get a UCL injury from repetitive stress to the elbow or from trauma. But throwers have the highest risk. That’s because throwing motions that twist and bend the elbow put extreme stress on the ligament.

Over time, the UCL can develop tiny or large tears. The ligament stretches and lengthens to the point where it can’t hold the bones tightly enough during throwing activities.

Pitchers are fully aware that at any moment, they can feel that pain in their forearm and/or elbow, and their career will be put on hold for that dreaded, but sometimes welcomed, Tommy John Surgery. As we all know, the surgery is named after former Los Angeles Dodgers pitcher Tommy John. In 1974, he underwent the first surgery of this type and when Dr. Frank Jobe, performed the first UCL reconstruction on Tommy John in 1974, a torn UCL tear was considered to be a game-ending injury for most players.

The surgery has evolved over time, but following Tommy John surgery, the players are typically immobilized in a splint or brace for 6 weeks, followed by months of physical therapy and rehabilitation. In general, players may not be ready to throw or pitch competitively for nine to 12 months after surgery. Oft times, it takes another year to fully come back. In fact, sometimes a pitcher comes back and throws even harder than before the surgery. Also, let’s not forget that pitchers are not the only ones who have Tommy John Surgery. Witness our own Corey Seager.

Complications can occur in anywhere from 5% to 20% of patients, depending on the technique that is used. The most common complication is damage to the ulnar nerve. Other complications can include infection or hematoma. Rarely, a complication will require additional surgery, but it does happen. At that point, a successful return to the mound is highly unlikely.

Johnny Venters is the only player to have it three times and make it back to the major leagues. The left-hander had his first procedure in 2005, in Class A. He made it to the Majors with the Braves in 2010 and was an All-Star in 2011. But he hurt his elbow and needed a second Tommy John in 2013. As he tried to rehab from that surgery, he tore his UCL again, requiring a third surgery. And as he rehabbed from the third Tommy John, he tore his UCL a fourth time.

But the way the ligament was torn allowed Dr. Neal ElAttrache to reattach it using a different procedure. Venters came back again. On April 25, 2018, more than five years after his last MLB game, Venters made it back to the mound with the Rays. In July, they traded him back to Atlanta, where he helped his original team win the NL East.

Many players have had Tommy John Surgery and have come back to pitch at a high level. He is a partial list:

  • Tommy John
  • Jacob deGrom
  • Adam Wainwright
  • Rich Hill
  • John Smoltz
  • Eric Gagne
  • David Wells
  • Billy Wagner
  • Brian Wilson
  • Joakim Soria
  • Francisco Liriano
  • Tim Hudson
  • Ryan Dempster
  • AJ Burnett
  • Chris Carpenter
  • Jamie Moyer
  • Stephen Strasburg

It is becoming more common for a pitcher to come back to his previous level of skill after Timmy John, but that is not a given. It is still a risk. Andrew Friedman is certainly not risk-averse… and that brings me to the point of this whole piece. Andrew has recently signed, drafted, or traded for several pitchers with a history of Tommy John surgery. Tommy Kahnle will likely miss all of 2021 with Tommy John and Corey Knebel is in his second back from the surgery. While Kahnle is a high-leverage reliever, he will likely not be ready until 2022, but Knebel should be back to his nasty old self next season.

Additionally, Freidman has added Jimmy Nelson, Brandon Morrow, Brock Stewart, James Pazos, and Carlos Asuaje to the team in various deals (mostly of the minor league variety). These deals are not to be confused with the signings of starting pitchers in the past, such as Scott Kazmir, Brandon McCarthy, or Brett Anderson. Those were all “stopgap” starting pitchers needed for a time until the Dodgers Farm System could begin to bloom again.

These pitchers are likely all relievers and other than Knebel, none are being counted upon. Even Knebel may not pan out. But, there is a good possibility is that of those six pitchers I just listed, one or two could play big roles for the Dodgers bullpen. The question is “Which Ones?” Now, it’s easy to just write all of them off, but at various times in each of their careers, all have shown at least flashes, of dominance. To me, it’s fun to watch this stuff play out.

Corey Knebel, Brandon Morrow, and Jimmy Nelson have all shown that they have dominant stuff. Nelson may have to re-invent himself as a reliever because the shoulder surgery he underwent what could be described as almost “complete shoulder reconstruction” by Dr. Neal ElAttrache, repairing his rotator cuff, anterior labrum, and capsule. Then, he underwent lumbar surgery in July that forced him to miss the entire 2020 season. This falls into the category of “you never know unless you try.”

You can expect to see more of this by Andrew Friedman. One key component is that these pitchers know the Dodgers medical and physical therapy staff is one of the best in baseball, the facilities are top-notch and they want to be Dodgers. They know that if they can make the team, they will likely play for a Championship. That’s huge! They also know that Andrew Friedman will see that they have a fair shot. That is also huge.

Then we can look forward to 2022 for Tommy Kahnle, who will earn $750K in 2021, and $3.45MM in 2022. He can also earn another $750K worth of incentives. HIs 100 MPH stuff is sometimes filthy. Again, this is a low risk-high reward move that Andrew Friedman loves to make.

By the way, if a player has a disease or surgery named after him, he should be in the Hall-of-Fame. Witness amyotrophic lateral sclerosis or ALS, which is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. It is now commonly called Lou Gehrig’s Disease, so Tommy John should also be in the Hall of Fame, and his 288 wins also don’t hurt.

The Hot Stove is not so hot!

This article has 78 Comments

  1. Oh man, you forgot to mention Hong-Chi Kuo! A survivor of two TJs. He had a couple of really dirty seasons with the club.

    It’s Merry Christmas Eve and still little action this offseason outside of the Braves signing one very old and one very mediocre starting pitcher. It seems like no one wants to bend and set the market.

    Back to TJ surgery. I would like to see one of the writers do some analysis on how long it has taken some of these pitchers to get back to peak form, rather than how long it takes to get back to a major league roster. As far as Knebel goes, it seems like he’s primed to back this season after trending upward at the end of last year.

    I’m not very confident about Nelson or Morrow. Morrow hasn’t pitched in two years and Nelson has thrown just 22 innings in the last three years. Both are lottery tickets and rightfully so. There’s always room for a dominant pitcher in the pen and if it doesn’t work out, it didn’t cost much.

    Now, let’s go get a couple of arms that actually look like they’re going to pitch at a dominant level for next year’s pen.

    I’ve read that the Indians are also listening on Jose Ramirez. AF needs to go shopping in that multi-family garage sale in Ohio. The Reds and the artist formally known as the Indians have some useful assets.

    Who would you rather have at 3B next year, Jose Ramirez or Eugenio Suarez, Kris Bryant or Nolan Arrenado?

    1. Merry Christmas. I would rather have Justin Turner at third base next season, but if I have to choose between the four you listed, Jose Ramirez is my choice — considering his offense, defense, and extremely team friendly contract; Suarez is very close second.

      1. I love Ramirez! Nice to have a switch hitter in the lineup. He sure packs a punch for 5’9″ package! Suarez is last on the list for me, but I still would love to have him. Arrenado has won the GG every year he’s been in the league which is quite impressive considering how many balls are tattooed playing at Coors field. KB is the only one of the four who’s won ROY and MVP honors. Can’t go wrong with any of them. But, to put JT at the head of the list at age 36? I’m not sure I follow the logic.

        1. Here is my reasoning. First Turner; in a trade for any of the four third basemen the Dodgers will have to part with a significant package of players/prospects. I would rather have Turner for 2021 with Kris Bryant a free agent after the season. possibly Arenado if he hates Colorado enough to opt out. Ramirez 2022 option is $11M ; $13M for 2023 — Indians may not be in a financial position to exercise those options, hence the rumor that he could be available now. Arenado – $199M over six years with his mediocre offensive stats away from Colorado puts him at the bottom of my list — unless he becomes a free agent. I would love to have Kris Bryant, but to play LF instead of 3b. If you look at the stats for the period 2017 to 2019 Suarez wRC+ is 128 while Arenado is 130, and Suarez is under team control through 2024 at $9.4M AAV. Hoese could play 3b in 2022, or I am one of the fans that believe the Dodgers could move Will Smith to third base so his bat is in the lineup every day.

          1. It doesn’t make a lot of sense to move Smith to 3B since Ruiz is essentially a left handed hitter. Ruiz would have to hit better than Rios and Smith would have to defend 3B better than Rios for that to happen.

            After we saw what DJLM did outside of Coors, with his horrific splits while he was a Rocky, I don’t see why we would expect anything different from Nolan, a better hitter overall. For every Vinnie Castilla, there’s a Matt Holliday.

            The prospect capital is a good point about these trades. But, the flip side is missing an opportunity for another title if JT continues his decline. At 36, there’s a better chance of that happening than Nolan becoming a poor hitter. With Nolan, at least the glove is going to be there. He’s the Ozzie Smith of third basemen.

  2. 2022 pitching staff could include Kahnle, Caleb Ferguson, Michael Grove (second rd 2018 draft), Braidyn Fink (19th rd 2019 draft), Clayton Beeter (2020 2nd rd supplemental draft), Aaron Ochsenbein (6th rd 2019 draft) along with Walker Buehler — all with TJ surgery in their medical files.

    MERRY CHRISTMAS DODGERS FANS!

  3. Since AF guided the Dodgers to a World Series I am more accepting of areas of disagreement. As a disclaimer I don’t intend to know what he knows which matters. He is planning for long term, short term, financial, etc. while providing the Dodgers with the depth unmatched by any other team. Now after affirming I am always amused by his blue light specials.

    How much money do u spend on a guy like jimmy Nelson who hasn’t pitched in 3 years? I’m estimating that he is already in for about 5 mil on him. Throw another 5 at Kahnle and then morrow will end up at 5 or more probably. Then u got knebel at 5 plus who is certainly no sure thing. Next thing u know u have quite a bit tied up on guys who may or may not pitch. I know spread the risk and short term. So, I know it is a philosophy a strategy. The investment is a lot more than just the salary but I understand if any of these pan out it would be worth it.

    Another strategy that takes me back to the McCourt days is to overpay for marginal players like pollock and Kelly. How the Dodgers acquired those 2 was giving extra years which nobody else is willing to do. How do I know that? That is what Kelly said. While pollock was good in the 60 game he has been a playoff bust and in his first year mr. injury as predicted. Kelly has just been a bust period. What a waste of talent.

    So, the strategy of blue light specials and disabled projects continues. So, how did we overcome? A fantastic farm, player development,using financial might in buying Betts, graterol, treinen, etc while paying to get rid of maeda, puig and others. So, it’s the way the market plays I suppose. I just get irritated when u add up all the money thrown away u could have had a good player or 2 and yet turn around and overspend on mediocrity. It seems contradictory but keep winning the World Series and this fan will be happy.

    1. The Pollock bashing is beyond unfounded at this point. After getting the plate removed from his arm, he’s been a consistent OPS of 880+.

      In case you weren’t paying attention, he lead the team in Home Runs last year for a mere $12M per season. Bad post season you say? Kike, Belli, Taylor, Smith and Rios all hit for a lower average and struck out more.

      Let’s not forget his .345 batting average against left handers last year. Yes, that lead the team. Only Rios had a better OPS against lefties. Pollock was a great signing by AF and is a very good player, borderline great player when healthy. And no he isn’t a platoon player either. Only JT, Mookie and Smith had a higher average against righties last year and his .881 OPS against righties was 3rd on the team.

      Please move on from the Pollock bashing. It’s silly that an injured player with a slow start has received such disdain from Dodgers fans.

      1. I conceded pollock had a good year for 60 games. He had a bad first year and a horrible playoff. This year he had a bad playoff but but not horrible he did hit lefties well last year and led us in homers. Not disputing last year other than playoffs. The trick will be can he stay healthy with 162 games(?). I believe the Dodgers are going to platoon him but we will see. His defense and speed have slowed so he is a left fielder. I hope he plays like you think he will but we shall c. If we have a full season we will c if he can stay healthy. I believe the Dodgers would be smart to platoon and try to keep him healthy. I appreciate your reply.

        1. He’s already played better than expected. Except for his first month…when he was clearly injured. He wasn’t in a strict platoon last year, and Joc is no longer on the team.

  4. Yes, Merry Christmas to all! I’ll be spending most of the day in the kitchen preparing for the feast of seven fishes. The trimmed down COVID version. On the menu for tonight.

    Course 1
    Assorted Cheeses, White and Peppered Anchovies, Seafood Salad with Calamari, Shrimp, Lobster and Scallops.

    Course 2
    Mussels in a white wine sauce and Bacala in a tomato sauce with Garbanzo Beans.

    Course 3
    Lazagna, Green Beans with garlic and Olive Oil, Salad

    Dessert
    Lemon Cloud Pie and assorted Christmas Cookies

      1. Hey Bobby, would you mind doubling up on your order and dropping half of it off here in Porter Ranch on your way back to SC?

        I’m married to an Italian and her family used to do the whole Christmas fish extravaganza when her dad was still alive. Lately we’ve done home made pizza on Christmas Eve and I ain’t about to complain about that.

        Merry Christmas everyone!

    1. Bobby and SoCalGrinch. We should plan a feast like this for the WS next year if you’re local. You still in SoCal?

    1. All the shopping! Italian store for D.O.P. tomatoes, Olive Oil, Bacala, Anchovies, Sausage and cheeses for the Lasagna. Santa Monica Seafood for the Seafood Salad. Various trips to Trader Joes, Albertsons for booze and other ingredients. Total Wine for Wine and European Beer (Not a fan of Craft Beers, I like my beer to taste like beer).

      I made the sauce on Monday and the Seafood Salad yesterday. Started soaking the Bacala on Tuesday (it takes 2 days to remove the salt).

      My wife just finished the Lemon Cloud Pie. It’s an old recipe from the 50’s that my mom cut out of a magazine.

      Basil, Lemons and Parsley are all home grown.

      Just finished putting together the Ricotta Cheese filling for the Lasagna. Just about to start the green beans which will be served at room temp. Then continue with the Lasagna. Then the bacala and mussels right before guests arrive at 5.

      I love cooking, so it’s fun for me. I used to cook a lot with my mom and it reminds me of her when I cook her old recipes. My kids are just starting to learn to cook from me, so hopefully some of these recipes will be passed down further.

      I made Risotto a couple of weeks ago with my son, who’s getting married in the Spring.

      1. SM Seafood is a great place! Spendy and across town so don’t get down there as much (used to live down the street, though).

        Sounds like a great spread, and if you got Risotto mastery down I’m impressed.

        1. You would die for my Risotto. You do get real Risotto at any restaurant because it has to be served fresh and you have to keep stirring it for the 20-30 minutes to get it really creamy. I make mine with saffron and usually serve shrimp or scallops on top. Sometimes, I’ll make it with wild mushrooms.

  5. Explain the following statement: While Knebel is a high-leverage reliever, he will likely not be ready until 2022, but Knebel should be back to his nasty old self next season. If he won’t be ready until 2022, how will he be back to his nasty old self next season?

    1. Wow! Nats scored. Nice pickup. Two years of control. I guess the Nats are trying to compete this year. That’s going to be a good one two punch with Soto.

      1. Nats must be counting on the universal DH. Defensively, Bell is the modern day equivalent to Dick Stuart (Dr. Strangeglove)

  6. I haven’t been on line for awhile. I just wanted to make sure I wished all you Dodgers fans a very merry Christmas.

        1. Merry Christmas EVERYONE. For those who don’t remember the uniform numbers of the Brooklyn Dodgers #14 belonged to Gil Hodges. That’s the reason why us “old timers” want #14 to be retired. Gilly was and still is my favorite all-time Dodger player.
          He was a very good player and a man among men. His stats may not be among the best but he had stats that are better than some in Cooperstown. At the very least his uniform should not be given out but should be retired just like #19.

          1. You are right Richie, and his stats almost mirror Hall of Famer Tony Perez, and if you look at the fact that Hodges was the best first baseman of his era. No one comes close. Musial played outfield and first.. Johnny Mize of the Yankees retired long before Gil did. Kluzewski was a lousy fielder. Gil won the first 3 gold gloves given for first basemen. Had they been handing them out earlier he could have easily won 10 of them.

      1. I realized long ago that Gil would not make it into the HOF. But I bet there are plenty of posters on this site that would love to see #14 retired. (There are a lot of “old timers” on this site) 🙂

          1. I’d love to think that he had a shot Bear, but the last time they voted on the “Golden Era Committee” I believe Gil only received 6 % of the vote. No body received enough votes to get into the hall.

          2. Great player, not a Hall of Famer. If he was, it wouldn’t be 60 years later. And Tony Perez has 400 more RBI than Hodges and Perez shouldn’t be in either. Perez never lead the league in anything except for grounded into double play.

          3. You ever see Hodges play Bulldog? I saw them both. Perez played 5 years longer than Hodges and only had 9 more HR’s in more than 1800 more at bats. Hodges was a great glove man and the best first baseman of his era. The writers got it wrong not electing him. Perez’s stats are from longevity as far as his RBI’s. But he was no where near the team leader Gil was. And he couldn’t carry his glove.

  7. What is especially cool about TJ surgery is the number of terrific players who have been able to continue their careers. Mark’s partial list confirms that fact. I think a couple of years ago there were 15 pitchers in the All-Star Game who had undergone TJ surgery. Prior to 74 all these guys would have been washed out. Countless players got hurt, never to be heard from again. I love the old-timers but nobody is correct when they opine that baseball was better “back in the day” before inclusion of players of color, foreign players and players who have had medical procedures keeping them in the game. How much longer might we have enjoyed Koufax if he had today’s medical procedures?
    Merry Christmas to all. Please enjoy the holiday and stay safe.

    1. Who is a HOFer who wouldn’t be without TJ surgery. It’s an advantage older era players didn’t have, same with PEDS.

      1. There are no Hall of Famers who have had Tommy John surgery. Most well known and successful are John, Billy Wagner, and Steven Strasburg. Syndergaard had it in March. Some well known names, but no one even close to hall worthy.

  8. Merry Christmas to all of you at LADT! I know that AF knows a lot more than I do, but I don’t quite get why it’s a better strategy to spend money on several injured relievers, than to pay for one proven high-leverage reliever who is not injured. Can anyone enlighten me?

      1. Aaron Burr was an idiot. He was also very egotistical. He thought he was the best option for the country. His killing of Hamilton caused him more grief than he thought it would.

  9. Well at least we know if AF doesn’t sign Seager as our future shortstop there always a place for him in our bullpen! Merry Christmas to everyone!

    1. They are said to be the favorite to sign a 17 year old SS out of Venezuela and the video of this kid shows some serious skills.

  10. I was busy doing some last-minute shopping today., but I wanted to address couple of things.

    #1 David asked: I know that AF knows a lot more than I do, but I don’t quite get why it’s a better strategy to spend money on several injured relievers, than to pay for one proven high-leverage reliever who is not injured. Can anyone enlighten me?

    #2 Threalton said: How much money do u spend on a guy like jimmy Nelson who hasn’t pitched in 3 years? I’m estimating that he is already in for about 5 mil on him. Throw another 5 at Kahnle and then morrow will end up at 5 or more probably. Then u got knebel at 5 plus who is certainly no sure thing. Next thing u know u have quite a bit tied up on guys who may or may not pitch. I know spread the risk and short term. So, I know it is a philosophy a strategy. The investment is a lot more than just the salary but I understand if any of these pan out it would be worth it.

    Answer: These are very similar issues. Let’s say AF signs Liam Hendriks, for probably 4 years/$48 Million. The odds are his best years were in 2019 and 2020. The odds are very strong he will not repeat that and/or will suffer an injury, like TJ and miss a couple of years. It happens all the time. Relievers are up and down, year-over-year. Very few are the same year-in-and-year out. A few years ago, everyone wanted Craig Kimbrell and Felipe Vazquez. Still want them? Every fan wants last year’s flavor of the year. If you trade for Josh Hader, you may get LH Kenley Jansen. Some of Hader’s peripherals and velo are a little scary.

    The Dodgers have $1,250,000 invested in Jimmy Nelson (that is for 2020 and 2021). That’s $625,000 a year
    The Dodgers have $4.2 Million invested in Tommy Kahnle over 2 years. That’s $2.1 Million a year.
    The Dodgers have minor league deals with Stewart, Pazos and Asuaje at a cost of $1.5 million a year TOTAL (but that does not count toward the Lux Tax)
    They have the most invested in Cory Knebel, which will likely be around $4-5 Million THIS year.

    If you add it all up, it equals $9.2 Million, but not all of it is on the MLB roster.

    There is a very good chance, that one of those pitchers will be as good or better than Hendriks in 2021 and if Joe Kelly can have one good year, then he might be worth it.

    I am sure that AF is a student of Statistics and Probability and he knows that his bets are spread out enough that it won’t hurt if they all fail, but if just one delivers, WOW! If more than one delivers, he hit the jackpot!

    That’s why he does it.

    1. Mark, I get it but if those guys like morrow etc. who are on minor league contracts do what is needed the price will go up. They will be put on the 40 man which will escalate the cost. If there is not room on the 40 man somebody will be sent down, traded, etc.

      We don’t know what the cost is but we shall see when the year plays out. We also don’t know the return until the year plays out. Hopefully, it turns out to be cost effective.

  11. Your explanation makes sense, Mark. I guess for that strategy to work, you really have to “buy low” – buy high potential relievers at fire sale prices. Thus, no Brandon McCarthy deals. It will be interesting to see if his strategy pays off.

    1. It doesn’t work all of the time, but it works enough to be worth it.

      The big thing is that it does not hamstring the team for a long time.

      The key is that it is part of a strategy… not the ONLY strategy!

  12. 2020 Dodgers left field reviewed

    · AJ Pollock
    Regular Season
    Overall (175 PA) — .276/.314/.566, 16 HR, 30 R, 34 RBI, 2 SB, 132 wRC+, 1.0 FanGraphs WAR, 0.9 Baseball Reference WAR
    As LF (95 PA) — .275/.295/.560, 8 HR, 16 R, 16 RBI, 1 SB
    Fielding, As LF — 1 E, .966 FP, -5 DRS, -19.6 UZR/150
    Postseason
    Overall — .220/.273/.268, 0 HR, 4 R, 2 RBI, 1 SB

    · Joc Pederson
    Regular Season
    Overall (138 PA) — .190/.285/.397, 7 HR, 21 R, 16 RBI, 1 SB, 55 wRC+, -0.1 fWAR, -0.3 bWAR
    As LF (69 PA) — .148/.235/.328, 3 HR, 9 R, 7 RBI, 0 SB
    Fielding, As LF — 0 E, 1.000 FP, -2 DRS, 0.7 UZR/150
    Postseason
    Overall — .382/.432/.559, 2 HR, 4 R, 8 RBI, 0 SB

    Chris Taylor
    Regular Season
    Overall (214 PA) — .270/.366/.476, 8 HR, 30 R, 32 RBI, 3 SB, 131 wRC+, 1.5 fWAR, 2.1 bWAR
    As LF (66 PA) — .291/.400/.491, 2 HR, 13 R, 7 RBI, 2 SB
    Fielding, As LF — 1 E, .971 FP, 3 DRS, 9.2 UZR/150
    Postseason
    Overall — .207/.270/.328, 1 HR, 8 R, 3 RBI, 0 SB

    1. Does Joc have options? We could sign him and have him spend the year at OKC. Then bring him back for the playoffs. Do you think he’d be upset with that strategy? We’d better not tell him before he signs.

      1. Joc will be the home run leader in Japan next year and would have to be signed by the Dodgers by the cut off date to be eligible for the Playoffs.

    2. I think it needs to be pointed out that Joc had 34 AB’s in the postseason, Pollock had 41 and Taylor had 58.

      Joc was clearly superior in the playoffs. That much is clear.

      1. Joc’s regular season fielding was better than Pollock’s as seen from the DRS and UZR numbers above. Taylor’s DRS and UZR stats were better than both Joc and AJ.

    1. Thanks for the link. After reading the article, it’s hard not to get really enthused about the next few years.

    2. It is really simple:

      The more prospects you have, the stronger the likelihood of some being stars.

      Hoard them… that has been AF’s mantra!

  13. Merry Christmas and Happy New Year to all you LADT and Dodger fans…
    When you start your spring cleaning, make sure you leave room on the mantle for some new 2021 W.S. stuff because you know we’re repeating!!!

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