According to NewChoiceHealth, the cost of the surgical treatment can vary anywhere from $9,600 to $14,400 depending on the place you choose. Only 10 percent of meniscus tears can heal by itself if there is an appropriate blood supply. Top . Variables that can help you increase your value that you can control are: Seek medical assistance as soon as possible after your accident, Document and track all changes in your mobility and health after you have been injured, Take photos of any visible swelling or symptoms. The majority of the time, according to runners who have had the treatment done, the tear did worsen until treatment was carried out. Does this patient have a torn meniscus or ligament of the knee? An MRI, often performed before the procedure is even considered, can cost up to $1,000, while a doctor can charge up to $349 for the office visit and viewing the results. i had my surgery June 14th and the surgeon said I had a 90% tear. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. This cartilage gives smooth interaction to the bones and prevents them from crashing to each other. . How Much Would It Cost To Buy A Hot Air Balloon. The American journal of sports medicine,32(6), 1479-1483. The most common knee surgery performed on people over 65 is repair of torn meniscus cartilage. In general, meniscus surgery is followed by a period of rest, walking, and selected exercises. Those with insurance coverage have actually reported paying anywhere from $100 to $320 after insurance coverage kicked in.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'thepricer_org-medrectangle-4','ezslot_1',155,'0','0'])};__ez_fad_position('div-gpt-ad-thepricer_org-medrectangle-4-0'); Treatments that are performed in foreign nations, such as Mexico and India, can vary anywhere from $3,000 to $7,000. In general, arthroscopy is typically a less invasive surgical procedure and can be less expensive. It is not advisable to accept these initial low offers and instead it is in your best interest to get support and assistance in maximizing your settlement value. Holmesglen Private Hospital Consulting Suite D1, 490 South Road, Ligament Conditions (ACL, PCL, MCL & LCL). Fabricant, P. D., Rosenberger, P. H., Jokl, P., & Ickovics, J. R. (2008). The clinical symptoms of torn meniscus include constant pain even with minimal movement on the knee, swelling, difficulty in straightening the knee, and a popping sensation. The best way to save money is to have your insurance company involved with the payment. The very best method to save money is to have your insurer involved with the payment. There are two surgical options for repairing a torn meniscus. To do this, he will need to take a history, perform a clinical examination and review your imaging findings. Additional factors in the amount of compensation is how much insurance coverage or other available assets the responsible party has. Cost of the ACL equipment (screws, buttons etc.) Alternative treatment methods, meanwhile, are far less expensive. Getting successful knee surgery can help prevent long-term complications like osteoarthritis. Press Release. In fact, you can find some of the best surgeons and world-class healthcare systems in the said countries. The surgery requires a few small incisions and takes about an hour. There are several considerations outlined below. As this is a day-case, there is no hospital overnight stay cost. Holmesglen Private Hospital Consulting Suite D1, 490 South Road, Moorabbin, VIC, 3189, If you don't have insurance or your insurance will not pay for your surgeryas is common with some weight loss procedures and most plastic surgeries there are ways to afford the health care you need, even if you must pay for the procedure yourself. Recovery and rehabilitation take a few weeks. Copyright 2023 attorney advertisement by Injury Advocates Group and licensed, practicing attorney Ray Benyamin, Esquire. The geographical area can affect the overall expense of the surgery. Swelling and stiffness. When a tear is presumed, imaging tests will be needed to verify the level of the damage. Predictors of short-term recovery differ from those of long-term outcome after arthroscopic partial meniscectomy. Crutches may be required to help ease the pressure off the joints after the surgery has been performed. This is, of course, assuming that you have no insurance. That said, just how much does a torn meniscus surgery cost? Symptomatic torn discoid lateral meniscus in adults. But this is often treated by conservative remedies but in severe cases, a surgery might be the best option of treatment. When you settle for a torn meniscus injury it is therefore important to make sure your future suffering is calculated into your settlement, something that you will face a challenge with as most insurance companies do not like to give fair offers on your future suffering. ? Most torn meniscus cases that are not the worst type of tear and can recover on their own can get an average settlement value that is under $10,000. There are several medical factors that can affect the. Answer (1 of 4): I recently had ACL reconstruction and meniscus repair surgery in India . A meniscus transplant is a surgical procedure to replace a damaged or missing meniscus. For. However, according to our research, the average surgery with no complications will cost anywhere from $3,000 to $11,000. Prospects for this kind of surgical treatment are frequently going to have discomfort when aligning the leg as well as swelling around the knee area. Condition: Tearing of the anterior cruciate ligament, also know as an ACL tear is usually an intense pain, a pop or snap, a loose feeling in the joint, and an inability to put weight on the affected limb. journal of orthopaedic & sports physical therapy,37(9), 541-550. When youre experiencing the symptoms of a torn meniscus, the best aid is to rest your body. The majority of owners can expect to pay between $1,000 and $1,500 for surgery to release the meniscus in a single knee. The time of recovery varies depending on: the type. The meniscus is a C-shaped piece of cartilage that acts as a . Do not be intimidated by insurance companies telling you that you cannot get higher pain and suffering settlement because you waited to get treatment and do not believe that just because your tear is small or you waited for treatment that you cannot expect a higher settlement in your case. Without this meniscus cushion, the ends of your tibia and femur may start to rub together abnormally. My injury happened in mid May. Your surgeons assistant will charge a fee that is generally about 20% of the surgeon's fee. The vehicle that swerved out of his own lane unsafely slammed into the plaintiffs car, forcing him into another car. SAMPLE VERDICT (Minnesota): $280,000. Patients typically have two options for treatmentarthroscopic partial meniscectomy that involves surgically removing the torn part of the meniscus and stabilizing it, or physical therapy. They said you have to push yourself because no one else is going to do it for you and when you do, youll find yourself on the top. SAMPLE VERDICT (Missouri): $18,500. In more serious cases, surgery will be needed for a torn meniscus but there is no one-size fits all surgery for a torn meniscus. Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. The meniscus tear surgery is an intervention carried out to fix or deal with several of the fibrocartilage strips in the knee, called menisci. In California, a torn meniscus case can range from as low as $10,000 to as high as half a million dollars or more. Generally, tears due to old age will be hard to repair. The average cost of torn meniscus surgery through arthroscopy is approximately $9,677 up to $11,675 or higher. On average, the surgery can cost anywhere from $5,000 to as much as $30,000 without health insurance. How much does torn meniscus surgery cost? Can a torn meniscus get worse? The injury caused the plaintiff to suffer knee pain that was later found to be caused by a torn meniscus. 5 months ago. Our muscles, limbs, and joints are slowly getting damaged and sometimes get dysfunctional. As for the national average, the cost is$11,900according toMeniscusTreatment.org. Blood work will need to be taken a couple of weeks prior to the treatment. Does this patient have a torn meniscus or ligament of the knee? Some variables can hurt you including waiting to get medical treatment, prior damage and surgery to your knees and advanced age. A 17 year old male passenger in a vehicle was struck by another car which was going through a stop sign without coming to a full stop. Plaintiff asked for full coverage of her medical expenses as well as lost wages. The tearing of meniscus is caused by enraged physical movements especially movements associated on the lower extremities. However, there are instances in which the extent of the injury is less severe. fractures and infections, are booked for surgery within 30 days. Arthroscopic surgery is often used to treat meniscus tears. A patients usual complaint when he or she tears the meniscus is swelling and pain that is on the knee, and there are different causes of a tearto the meniscus, but this usually happens to athletes since they tend to be more active. This is according to the surgery price estimator of St. Elizabeth CHI Health. Should I Accept My Torn Meniscus Settlement Offer? The torn meniscus is repaired by a variety of minimally invasive techniques and requires postoperative protection to allow healing. Our team is made of world-renowned, experienced journalists who sign and abide to our strict rules and editorial ethics policy. If you are uninsured and would like to consider surgery in a private hospital, please contact Mr Pais rooms. Otherwise, a doctor may recommend arthroscopic surgery, in which instruments are inserted into a tiny incision in the knee. This led to a torn meniscus and a knee contusion but the defendant denied liability and stated that the plaintiff lost control of his car for an unrelated reason. The cost of ACL surgery varies widely across the country and from facility to facility. Page . If its minor, then the doctor may recommend a natural remedy such as resting and elevating the knee, but if its severe, surgery may be the next step. Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear. There are 2 types of surgical treatments that can fix a meniscus tear. In most cases, the person will have to undergo surgery of their torn ACL. ). Over time, this can cause persistent knee pain. According toHowMuchIsIt.org, prices can go anywhere from$5,000to a whopping$30,000. When preparing for surgery, you should consider the cost of post-operative physiotherapy and rehabilitation. This is because Mr Pai will need to determine the need for surgery, the type of surgery and its complexity before providing you with an accurate quote. It is possible that your torn meniscus injury can become permanent in many ways. So, its often the first choice for those who have an active lifestyle. It helps keep the knee from gliding anteriorly. Mr Vishal Pai | Consulting LocationsSandringham Orthopaedic SpecialistsHarcourt Specialist CentreKnox Private HospitalWattletree Consulting Suites, Phone: (03) 8657 0595Fax: (03) 8657 0596Email: admin@vishalpai.com.au, 2023 Mr Vishal Pai. After recovery from the acute injury, some people are able to resume normal sporting activities, however most cannot because of persistent knee pain and swelling. The defendant claimed that liability was not his fault and that because of his insurance policy he should not be liable to pay. The late August sun can leave a mark. There are two kinds of surgeries that can repair a meniscus tear. The Hospital charged $ 26K to use their facility for two hours, the doctors charged another $ 12K for their valuable time and the MRI was $ 2K so total cost for this little clean up job was $ 40K. Surgeon's meniscus repair fee - $4,629.00 Surgeon's knee arthroscopy fee - $4,629.00 Surgeon's ACL repair fee - $8,011.00 The rest of the charges were as follows: Anesthesiologist fee - $2,124.00 Consumables - $2,603.00 Drugs - $7,087.13 Equipment - $11,382.00 Facilities - $28,515.00 Usually, this surgical treatment can cost anywhere from $5,000 to as much as $30,000 without medical insurance. An adult female was rear ended on a public roadway with enough impact to cause multiple injuries, including a lateral meniscus injury to her left knee. Meniscal repair surgery can greatly reduce these symptoms for patients that are a good candidate for surgery. For instance, meniscus surgery can cost about $15,000 in Los Angeles and around $9,000 in Atlanta. Meniscus tear surgery is a surgical procedure performed to correct or treat one or more of the fibrocartilage strips in the knee, known as menisci. In USA depends, cash price is different vs insurance, also depends on surgeon and clinic, also there is a bill for hospital room etc. The impact of the injury was strong enough that it caused the plaintiff to require traumatic left-knee meniscus tears which needed arthroscopic surgery and the need for additional future surgery as well. Jama,286(13), 1610-1620. When surgery was a definite and a date set, I asked several times for an "estimate", which no one could give me. TPLO Surgery: $3250 USD for the basic procedure or $3698 USD will include physical therapy and follow up X-Rays and check ups. Serving all of California, with a focus on Kern County, Los Angeles County, Orange County, Riverside County, San Bernardino County, San Diego County, Santa Barbara County, and Ventura County. There are a few common surgical techniques used to repair the cruciate ligament in dogs. Also read about the cost of bunion surgery, brachymetatarsia surgery, and foot corn surgery.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'thepricer_org-box-4','ezslot_3',137,'0','0'])};__ez_fad_position('div-gpt-ad-thepricer_org-box-4-0');if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'thepricer_org-box-4','ezslot_4',137,'0','1'])};__ez_fad_position('div-gpt-ad-thepricer_org-box-4-0_1');.box-4-multi-137{border:none!important;display:block!important;float:none!important;line-height:0;margin-bottom:7px!important;margin-left:auto!important;margin-right:auto!important;margin-top:20px!important;max-width:100%!important;min-height:250px;padding:0;text-align:center!important}. Pain medication and prescriptions will be prescribed after the procedure to keep the pain at a minimum. The recovery outlook for a badly torn meniscus is not very positive because surgery itself can lead to complications. SAMPLE VERDICT (Michigan): $15,195. 4 to 6 weeks. Tears associated with arthritis often improve over time with treatment of the arthritis, so surgery usually isn't indicated. With the ongoing COVID-19 pandemic, waiting times have increased. It is best to consult a doctor or pharmacist for the right dosage regimen for you. It is important to be safe with your mobility and follow the appropriate post-operative precautions. Therefore, you can tear your meniscus in a car accident and it happens more frequently than many would expect. The least expensive Arthroscopic Knee Surgery in Orlando is $2,700 for a Knee Repair Surgery while the most expensive Arthroscopic Knee Surgery list price is $6,900 for a Acl Reconstruction Surgery. Consider talking with at least three different hospitals. For those with insurance, the rates can be $10 to $50. Symptoms of Torn Meniscus This itself will come with a visit to an ER, or to a doctors office to have the affected leg checked out. So, if the injury is severe and symptoms refuse to disappear even after treatment, your doctor might recommend a surgery. Nothing on this website is, or should be taken as, legal advice. I had a 25% co-pay of approved charges, $2800. A highly questionable practice without supporting evidence of even moderate quality With 150 000 knee arthroscopies carried out in the United Kingdom each year, and about five times that number in the United States,1 2 arthroscopic partial meniscectomykeyhole surgery for middle aged to older adults with knee pain to trim a torn meniscusis one of the most common surgical procedures. Talk to your medical insurance company to make sure that a treatment such as this is covered. Instead, removing parts or all of your menisci will be the solution. Before the procedure is even considered, the doctor will want to run a series of tests to determine the extent of the damage. According to PlacidWay.com, torn meniscus surgery can cost an average of $9,000, but the price can increase to $30,000, depending on the chosen surgical procedure, location, surgeons fees and the hospitalization costs. Just as people can pull or tear the muscles, tendons, and cartilage in their knees, dogs can tear their menisci as well. Remember these considerations before you go ahead with the procedure. MOR Package Price: $10,800. Crutches, splints, cast shoes, slings, walking boots, etc. Orthopaedic implants and equipment can come at a considerable expense. This is according to the surgery, Have I mentioned that torn meniscus does not always require a surgery? Theres no doubt that a meniscus tear surgery is expensive. Fixing the meniscus will also help restore the knee. Meniscus surgery can cost about $15,000 in Los Angeles and around $9,000 in Atlanta. Total amount that I paid was around 300000 rupees which is approximately 4000 dollars . A 50 year old female driver was hit by a driver who had swerved out of their lane and collided with her vehicle. The initial treatment includes nonoperative management consisting of rest, elevation, ice, medication, and reduced activities. . Cost Factors The exact meniscus tear surgery price will depend on the following factors: Severity of the damage Your doctor may also prescribe physical therapy to improve your leg's range of motion and strengthen the muscles around the knee. Better be safe than sorry, right? The exact length of this recovery varies with the type and severity of the tear, the procedure performed, and the patient's health status, but it can be as long as six months. When a tear is suspected, imaging tests will be ordered to confirm the extent of the damage. Article Author: This law article was written by attorney Ramin Benyamin, Esquire. Meniscus Surgery Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. There are essentially 3 levels of treatment for a torn meniscus: (1) conservative; (2) therapy; and (3) surgery. swelling - this usually happens several hours after you injure your meniscus. On average, each night you stay in hospital costs $1000-$1500 per day. . Depending on the type of surgery you will require an extensive course of rehabilitation which may last 6-10 months. Patients get assigned into three categories: Category 1 patients having the most urgent problems, e.g. A sudden stop or barbaric pivoting can tear the meniscus. content.healthaffairs.org/content/26/3/780.full?ijkey=L6moAROSh5koY&keytype=ref&si www7.aaos.org/member/directory/directory.aspx, Check Out All Costs for Health & Personal Care. The success of specific procedures, like ACL reconstruction, is highly dependent on appropriate rehabilitation. Notify me of follow-up comments by email. Service Request. The price is determined by the scope of the surgery, the surgeon, and the location of the damage. on their aesthetic clinics. Arthroscopic meniscectomy is an outpatient minimally invasive surgical procedure used to treat a torn meniscus cartilage in the knee. For instance, the average cost of torn meniscus surgery in India and Mexico is about one-third of that in the US. You will pay less if your doctor has a prior agreement with your insurance company. The more serious the surgery, the higher the chances for bleeding, inflammation, and nerve or blood vessel injury are. Torn Meniscus Sample Verdicts & Settlements, Supporting Citations, Literature & Resources. : value of the physical examination. : value of the physical examination. The average cost of torn meniscus surgery will depend upon the type of treatment. Usually, this surgical treatment can cost anywhere from $5,000 to as much as $30,000 without medical insurance. . Depending on the hospital or surgical center, youll also have to consider the following expenses: To avoid getting surprised by your bill, confirm the additional costs with the hospital or center. This non-surgical process requires you to rest and use ice, compression, elevation, and some therapy. After the surgical treatment has been carried out, physical treatment will be needed for the next 2 to 8 weeks. Is the average Settlement for a torn meniscus in my state different? Torn meniscus (medial) Edge of meniscus was cut. Both treatment options take a multitude of weeks to recover from. The meniscus is always trying to heal itself and a stem cell injection could give your meniscus the needed boost so that it can heal itself completely. looking at partial knee replacement now but with different surgeon. A meniscus tear is a common knee injury. Our writers are experienced journalists who adhere to our strict, Over-the-counter aids to address mild pain caused by a torn meniscus typically cost, For insured patients, out-of-pocket costs typically consist of a specialist copay, possibly a hospital copay of, According to the American Academy of Orthopaedic Surgeons[. . Category 3 patients have non-urgent conditions, and the waiting time for surgery is within 365 days. you may need arthroscopy surgery to repair or remove the damaged cartilage. There are some that small and not serious and others that are large tears in abnormal shapes that make recovery and treatment much harder. $2,673,000 total damages, with $1,400,000 of that for pain and suffering, for a plaintiff who slipped on grease, tore his meniscus, was unable to perform . I was out. Each surgery is associated with one or several Medicare Benefits Schemes (MBS) item numbers. The plaintiff denied liability and stated the accident was the fault of an unidentified third party. The exact meniscus tear surgery price will depend on the following factors: As said earlier, the meniscus tear surgery price dramatically changes depending on your location. Diagnostic studies and additional lab work. Clinical Orthopaedics and Related Research,468(12), 3399-3405. You can also ask them. Walk without crutches. These costs can differ from one surgeon to another and can be based upon professional experience, competence, and type of surgery. (2006). Brought own crutches (would have been same amount). Meniscus transplant is breakthrough procedure. August 07, 2018. The menisci in the knee act as shock absorbers and can be torn or damaged, causing pain and some mobility issues. You will receive a 75% reimbursement from the value of the MBS item numbers quoted. Torn meniscus car accident settlements, like most settlements often rely on you getting swift treatment for your injury. This itself has been linked to future arthritis pain. As noted before, a meniscus tear from a car accident may not be immediately evident after your accident. ACL reconstruction usually would be considered medically necessary and covered by health insurance. This healing duration will depend on how complicated the surgery was. For a knee replacement, the average cost can range from $17,00 to $30,000, whilst a knee cruciate ligament repair can cost between $5,000 and $14,000 so it's worth shopping around for the most affordable option. If thinking about a path such as this one, make sure to do your research prior to selecting a health center given that it can be really dangerous. Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. How Much Does Growing Medical Marijuana Outdoors Cost? Placing a pillow under the knee to incline the affected area is a good remedy, too. There are alternative treatments you can try that are drastically way cheaper than the, It is still best to consult your physician or an orthopedic to get the right assessment and the precise treatment for your situation. Healthcare costs in private can be expensive. They can cover a minimum of 60% of the overall expense, which can make your expense cost extremely low. If the surgeon is able to repair the tear, it may take around 4-6 weeks for you to . Histology of the Torn Meniscus: A Comparison of Histologic Differences in Meniscal Tissue between Tears in Anterior Cruciate LigamentIntact and Anterior Cruciate LigamentDeficient Knees. The jury rejected this and passed a verdict in favor of the plaintiff. An Arthroscopic Knee Surgery in Orlando costs $7,686 on average when you take the median of the 45 medical providers who perform Arthroscopic Knee Surgery procedures in Orlando, FL. Book your consultation SUMMARY Cost of surgery. Please read our disclosure policy for more info. When the knee moves in a jerk motion without warning and in an unnatural manner, this causes the potential for a meniscus tear. The IAG team is here to help you navigate what can be a complex, stressful and difficult process 24/7. A jury awarded in addition to the $91,000 settlement, a verdict giving the additional amounts for lost wages and medical expenses. A meniscus tear is a common type of damage to cartilage in the knee. Ahn, J. H., Choi, S. H., Lee, Y. S., Yoo, J. C., Chang, M. J., Bae, S., & Bae, Y. R. (2011). Sex differences in factors influencing recovery from arthroscopic knee surgery. In the adolescent, acute swelling of the knee joint at the time of injury is common. It is important to get full information to things you have to pay when getting a surgery for torn meniscus. Regenexx procedures are intended to help avoid the side effects of surgery and support the healthy, cushioning environment the meniscus provides for the knee. Getting effective knee surgery can help avoid long-lasting problems like osteoarthritis. In the edge of the cliff, athletes are even more prone to physical damages that can harm them persistently and can affect their sporty life. For those who have a medical insurance policy, this treatment will most likely be covered as long as it is considered clinically required. . Once the referral is received, there is a considerable wait time to see a surgeon for an elective procedure. For example, a single ACL fixation screw can cost around $450. According to our detailed research, the average surgery without any complications will cost anywhere from $3,000 to $11,000. Else, you will have a hard time functioning normally. To put that in a brighter sentence, the price will depend on the length of time spent for the surgery, the number of days the patient had stayed in the facility, supplies and medication, additional examinations, and other special care services. Since theres no blood supply, this type of tear cant heal itself, only making the situation worse. Just how much does a meniscus tear surgery cost? Navigating the cost of private healthcare can be confusing. The average cost of torn meniscus surgery through arthroscopy is approximately $9,677 up to $11,675 or higher. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); How Much Does a Torn Meniscus Surgery Cost? Meniscal repair surgery is a type of orthopaedic surgery that repairs the meniscus in the knee. Our orthopedic practice is located in sunny Santa Clarita. The bigger variable will not be your state, but the extent of your injury and the level of treatment that you end up needing. With arthroscope, the special can fix, trim, or adjust the meniscus with other special equipments. If the tear is small and on the outer portion of the meniscus, it may be enough to simply rest, ice, bandage, and elevate the knee. Elevation. The approximate cost can range from $3,500 - $4,500. If not treated, part of the meniscus may come loose and slip into the joint. The cost of a private orthopaedic surgery consultation without health insurance typically costs 200-300 at a private hospital or clinic in the UK. I recently had surgery on my right knee, torn meniscus on my inner knee. If you get a meniscus tear and you don't go to the doctor, you could experience any or all of the following issues. Select StateAlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming. Meniscus Surgery Cost in India. A jury awarded $12,195 for allowable expenses and another $3,000 for interest on overdue No-Fault Insurance benefits. You will receive a 75% reimbursement from the MBS item numbers quoted. But the surgery usually takes only 20 minutes to 1 hour, but in severe cases that require extensive invasive operation like blood transfusion, the patient may stay on the hospital of up to 3 days. Physical therapy is cost-effective and has been proven to therapeutically relieve the pain and heal the affected area. Most likely, your doctor will recommend that you rest, use pain relievers, and. In the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial . This means that over time, you may find that additional health problems arise, such as arthritis and the need for further surgery.