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For severe ankle injuries, chronic instability, or post-surgical recovery, the combination approach warrants serious consideration

While highly effective at lowering recurrence rates, tamoxifen can trigger metabolic changes that promote weight gain, increase appetite, and slow energy expenditure

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Inflammatory markers such as TNF- and IL-6 are also under active investigation, particularly in studies evaluating anti-cytokine therapies (e.g., infliximab, tocilizumab) [342]