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A Distalising Tibial Tubercle Osteotomy for Patellar

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A Distalising Tibial Tubercle Osteotomy for Patellar 05?@-85?5:[email protected]@A.1>/81;?@1;@;9E2;><-@188-> @1:05:;<[email protected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