As the knee bends (flexion) from a fully straightened position, the patella descends into the trochlea, but does not fully enter this groove until approximately 20-30 of knee flexion. Medial dislocation of the patella is a previously unreported entity. due to repetitive microtrauma to the ACL graft15,20or by debris that is present within the knee joint from the drilling and preparation of the tibial tunnel during ACLR.21The consistency (i.e., soft or hard) of the cyclops lesion may be a factor in whether or not loss of knee joint extension or worsening of clinical symptoms occurs after ACLR22. Computed tomography (CT) CT is not a first-line imaging modality for diagnosing patellar dislocation. Meniscal Untethering/Extrusion 4 min. Inhomogeneously edematous lateral vastus muscle compartment indicating simultaneous muscle injury. MRI has been found to be 85%-92% sensitive for diagnosing MPFL injury (Seeley, 2013). . It, The posterior cruciate ligament (PCL) is one of four ligaments that hold the knee in place and provide added stability. Although these articles do not have all bibliographic details available yet, they can be cited using the year of online publication and the DOI as follows: Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names, and use of punctuation. [1] Also, look for: Any resultant fractures of the patella Knee effusion, seen as increased space under the patella. A related to higher probability of reoperation. This is due to the dislocation, with the patella hitting against the femur to cause the fracture. Medial Patellofemoral Ligament (MPFL) Tear X. In a normal trochlea (a), the patella (sphere), guided by forces from the quadriceps tendon, patellar tendon, and medial and lateral supporting structures (red arrows), begins each cycle of knee flexion by entering the shallowest, most proximal portion of the trochlea (upper portion of diagram). The tibial collateral ligament is also called the superficial medial collateral ligament. $ 30.00. Journal of Orthopaedic Surgery and Research, Vol. Small foci of cartilage injury within the patella and posterior tibial plateau. At that point there are three landmarks: the inferomedial geniculate artery and paired veins (figure). Use of this site is governed by our, DISCUSSION ON PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE. The patellofemoral indexis the ratio between the thickness of the medial joint space and the lateral joint space (L). Not done in this case. Additionally a fracture fragment is present adjacent to the medial femoral condyle. Surgical procedures of the percutaneous lateral release and medial reefing for recurrent patellar dislocation of the left knee. We regard this roentgen finding as pathognomonic evidence of previous lateral dislocation of the patella. 27562-RT Dislocation, patella, closed treatment 6. This means the kneecap is displaced off to the side, which often occurs as the result . Order now. More specifically, the PCL, The arcuate popliteal ligament is a thick and fibrous band of connective tissue that is connected from above to the femur's lateral condyle, the bony, The patellar ligament is an extension of the quadriceps tendon. Afracture or cortical irregularity of the medial articular margin of the patella was noted in a number of patients admitted to The Hospital for Special Surgery, New York, with the diagnosis of recurrent lateral dislocation of the patella. The femoral artery is one of the major arteries in the human body. Three cases are presented in this article in which computed tomography demonstrated the dislocation. 27514-LT Fracture, femur, distal 7. Last medically reviewed on January 22, 2018. 11, Fibula. This is a 14 year old patient with history of fall. (CVA) in association with a Taser-induced electrical injury," Emergency Radiology, vol. Ecchymosis was also noted on right side of the body over the knee, thigh, and shoulder. No marginal fracture is visible. Assessment of Patellar Dislocation: Assess neurovascular status distal to the patellar The apprehension test can be used to assess for patellar dislocation and subluxation. Ligaments are bands of fibrous, durable tissue that connect and, The oblique popliteal ligament crosses the back of the knee joint. Records of 150 patients admitted to the hospital with a diagnosis of lateral dislocation of the patella were obtained, and their roentgen examinations and charts reviewed. ADVERTISEMENT: Supporters see fewer/no ads. It is usually an iatrogenic complication of surgical lateral retinacular release. It is situated deep to the vastus lateralis muscle, ranging from the posterior aspect of the medial femoral condyle to the superomedial part of the patella, vastus medialis and quadriceps tendon. Unknown Knee Case: Pediatric Meniscus Injury 6 min. A ligament is a type of, The lateral meniscus is attached to the shin and is located on the outer side of the knee. In 16 cases, 12 females and 4 males, the fracture of the medial articular margin of the patella was demonstrated. In the case of knee extension, this movement happens by the patella offering leverage that the quadriceps tendons it's attached to can put on the femur. 29515-RT Splint, leg, short Note: E/M code 99283-25 is applicable in this case. 5. BTB reconstruction is performed with the patellar tendon along with two bone fragments. The deep part of the MCL, even when it is normal, you may not be able to see. 21, no. Home Musculoskeletal radiology Lateral patellar dislocation Lateral patellar dislocation Tuesday, August 30, 2016 Musculoskeletal radiology Lateral patellar dislocation is lateral displacement followed by dislocation of patella due to disruptive changes to the medial patellar retinaculum. Risk factors for recurrent patellar dislocations include 5: trochlear dysplasia patella alta increased patellar tilt increased femoral internal rotation Radiographs should be obtained to document reduction. Its not common to see femoral fractures with a patella dislocation and this indicates how forceful the dislocation must have been. First-time patellar dislocation typically occurs with twisting knee motions, during which the medial ligamentous stabilizers rupture, and the patella strikes against the lateral femoral condyle. The superficial medial collateral ligament (MCL) extends from the medial epicondyle to insert not just near the joint but 7 cm below the joint space. The PFL and arcuate ligament were seen to attach directly to the posterior and medial aspect of the styloid process of the fibular head. Knee dislocations are high energy traumatic injuries characterized by a high rate of neurovascular injury. When your knee is dislocated, the femur and tibia no longer connect at the knee joint. Rupturing, or tearing, of the medial patellar ligament can be the cause of this issue. Quinn described the MRI findings following acute patellar dislocation as contusion or impaction of the medial patellar facet and lateral femoral condyle, along with injury of the medial retinaculum and/or medial patellofemoral ligament (MPFL) (Quinn, 1993). TPD is often occult in children. These results suggest that the OA unloader brace may reduce medial compartment joint loading during dynamic loading activities. MRI of the knee demonstrates characteristic appearance of recent transient dislocation of the patella. This ligament is almost always torn with patellar dislocations. The medial ossification can be seen within the MPFL or the medial joint capsule, suggesting remote injury to these structures. ray you need to do a horizontal view with the patient lying down in order to see the fat fluid level. The patellofemoral compartment is part of the knee joint and is formed by the patella and the groove (femoral trochlea) at the lower (distal) end of the thigh bone. Description. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Patellar dislocation. This process produces a predominantly chondral fracture at the margin of the articular surface, which becomes radio-graphically visible only when a sufficient portion of subchondral bone is involved. in Obesity) Knee Dislocation is a risk for vascular injury, and missed dislocation risks limb loss XI. This modified Schenck anatomic-based classification system is most commonly used in clinical practice and adequately describes most traumatic knee dislocations by accurately describing the injured structures, including the ACL, posterior cruciate ligament (PCL), MCL, lateral collateral ligament (LCL) and posterolateral corner (PLC) [ 6 ]. Tap on the below button when you are Online. The medial patellar ligament is located in the second layer of the knee. 9, No. 2, Quadriceps tendon. decrease in the rate of medial meniscus repairs relative to medial meniscus injury was associated with delayed time to Jungmann et al, 77 in a study of 88 . CLICK ICON BELOW TO SEE ALL OUR INSTAGRAM POSTS, MORE WHAT'S THE Dx POSTS: CLICK THE IMAGE BELOW, RETROCALCANEAL BURSITIS RADIOLOGY MRI ANKLE, KNEE PLICA MRI MEDIAL PATELLAR PLICA RADIOLOGY. Medial femoral condyle fracture (Green Arrow), PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE, PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE: MOVE SLIDER ICON TO VIEW, IMAGES ARE FROM OUR INSTAGRAM ACCOUNT. The aim of this paper was to determine the influence of smoking on functional outcomes after isolated all . We describe the clinical, ultrasound (US), and magnetic resonance (MR) imaging features of a transient medial patellar dislocation in a 19-year-old patient with trochlear groove dysplasia presenting no surgical history. 211 . Diagnosis is made clinically with careful assessment of limb neurovascular status. in stock. Conclusion: Cartilage shearing injury involving the posterior aspect of the lateral femoral condyle. A concurrent finding also previously described (14), the compression fracture or irregularity of the lateral margin of the lateral femoral condyle, was seen in only a few cases. 174, No. This means the kneecap is displaced off to the side, which often occurs as the result of falls or sports injuries. These fibers attach and course from the superficial medial collateral ligament toward the patellar bone, or kneecap. Knee Case Review: Medial Meniscus Attachments on MRI 5 min. The impingement of the medial margin of the patella upon the lateral condyle causes a compression defect in the condyle and a fracture of the medial margin of the patella either by compression or by shearing as the patella slides back, pulled by the contracting quadriceps. It is a thin, circular layer of tissue that. This site uses cookies. patellar restraints (81% of patients). web1! Fracture of lateral and medial malleoli as well as posterior lip of distal tibia . The medial patellar ligament originates at the medial epicondyle (an area of bone at the top of the femur) and medial collateral ligament (MCL), an important ligament located on the inside of the knee. Early recognition of bone bruising of the patella and lateral femoral condyle, associated osteochondral injuries, and medial patellar stabilizer injury is important for timely diagnosis. PATELLA DISLOCATION SUBLUXATION FRACTURE HEMARTHROSIS LIPOHEMARTHROSIS MRI KNEE RADIOLOGY - Radedasia PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE DISCUSSION ON PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE WHAT ARE THE XRAY FINDINGS? 17 Magnetic resonance images acquired at 1.5 T or 3 T allow the radiologist to visualize internal . From the case: Chondral delamination - knee. Study free Radiology flashcards about RAD Pathology created by bre092795 to improve your grades. 6, No. Large joint effusion. Its primary function is to supply blood to the lower section of the body. It is about eight to ten centimeters long and stretches from, The fibular collateral ligament is one of the ligaments that make up the knee joint. When the medial patellar ligament ruptures, it is typically caused by the lateral dislocation of the patella. The purpose of this presentation is to discuss and illustrate the roentgen abnormalities which follow lateral dislocation of the patella and to point out the importance of the tangential view of the patella in the examination of the knee. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Download Citation | On Dec 1, 2022, V.S. On X-ray we can't say defnitely that it's a hemarthrosis but the presence of a fracture would indicate that it is likely to be a hemarthrosis. Our website services, content, and products are for informational purposes only. Meniscal Zones 5 min. Patellar instability, or unstable kneecap, is a common condition of the medial patellar ligament where the kneecap is out of its proper place. Laterally subluxated patella, edema at the medial patellofemoral ligament (MPFL) attachment. Smoking could be an important negative factor in isolated meniscus repair. The joint most commonly evaluated with MRI is the knee: noncontrast 1.5 T and 3 T MRI have replaced diagnostic knee arthroscopy, which was still performed in large numbers at the beginning of this century in patients with unclear symptoms. Report Report even the absence of dislocation or fracture. A dislocating patella in a patient eight years of age is demonstrated in Figure 1. We regard this roentgen finding as pathognomonic evidence of previous lateral dislocation of the patella. This disorder can be disabling to the patient and may require a hospital visit for reduction. The injury mostly occurs due to twisting of knee when knee is in mild flexion (<30) which leads to injury of medial stabilizers and medial aspect of patella strikes against lateral femoral condyle. When the medial patellar ligament ruptures, it is typically caused by the lateral dislocation of the patella. All rights reserved. There is also a bone contusion of the inferomedial patella. 1 Department of Radiology, Veterans Affairs Medical Center, University of . Acute traumatic patellar dislocation is the second most frequent cause of traumatic hemarthrosis of the knee, after anterior cruciate ligament tear, and accounts for 3% of all traumatic knee lesions [1], [2]. Three cases are presented in this article in which computed tomography demonstrated the dislocation. 2, pp. 6, Gracilis muscle. Patellar instability may be treated with nonoperative management in the beginning, such as immobilization and special exercises. Use the menu to find downloaded articles. Radiology . All were managed identically with an active rehabilitation program involving partial or no immobilization. 24516-RT Fracture, humerus, shaft Exercise 4.18 Musculoskeletal System 1. Medial patellar ossification correlates with a history of prior patella subluxation and/or dislocation. Additional passive stabilizers include the medial patellotibial ligament (MPTL) and the medial patellomeniscal ligament (MPML). 14.1 ). Although the clinical examination for each joint involves a similar approach (the 'Look, Feel, Move' format), be it the shoulder, hip or knee, many students can find the subtle differences between each examination . This condition can result in pain, swelling, and difficulty using the knee. 1, EMC - Radiologie et imagerie mdicale - Musculosquelettique - Neurologique - Maxillofaciale, Vol. Postoperative MRI shows tendon healing and no visible defects. US is not a first-line imaging modality for patellar dislocation; however, it may be used to detect medial patellofemoral ligament injury during the postreduction follow-up period. Check for errors and try again. Apprehension sign occurs when the knee is placed at 30 flexion, and lateral pressure is applied. Here the fracture is purely chondral in nature and therefore invisible. It is usually due to trauma sustained during physical or sports activity. A fibrous band of tissue, this ligament is both broad and flat in shape. The medial patellofemoral ligament has intrinsic signal and is disrupted at the anterior patella . 5, Greater saphenous vein. During four academic years (1974-1978) at a major university, 51 of 70 knee injuries sustained by football players were Grade I or II sprains of the medial collat eral ligament of the knee. Radiographic features Plain radiograph Damage to medial stabilizers leads to recurrent patellar dislocation, especially if there are additional anatomical risk factors such as . . By continuing to browse the site you are agreeing to our use of cookies. Healthline Media does not provide medical advice, diagnosis, or treatment. Medial patellofemoral ligament injuries can be classified based on the type and/or location 1,6-8. 7 The time period between patellar dislocation and MRI was not mentioned, and the mean age of patients was 20 years with a wide . Nayak and others published Morphological Study of the Transverse Ligament of Knee Joint in Embalmed Cadavers | Find, read and cite all the research you . All three patients had undergone a lateral retinacular release to the involved . The third edition of A Comprehensive Review of Musculoskeletal MRI provides a thorough review and update of techniques and protocols in this specialized imaging area. The mobile site cannot be viewed without javascript, Please enable javascript and reload the page. The patient has had a recent patella dislocation and there is now a large suprapatellar effusion (on MRI this was a hemarthrosis). The sensitivity and specificity of ultrasound for Achilles tendon rupture, as reported within the radiology literature, are 96% to 100% and 83% to 100%, respectively. The bony structure of the patellofemoral joint is another static stabilizer, especially during deeper knee flexion angles. The typical injury pattern is a tear of the medial patellofemoral ligament (MPFL) and bone bruises of the patella and the lateral femoral condyle. This disorder can be disabling to the patient and may require a hospital visit for reduction. In none of the 16 cases was any congenital abnormality of the patella such as hypoplasia demonstrated. 2005-2022 Healthline Media a Red Ventures Company. On postoperative MRI, it appears as an area of defect on the central third of the patellar tendon after the surgery. With the knee 20 flexed, it should measure 1.6 or less. A history of previous trauma was obtained in 12. We assume that the fracture also occurs in younger children but is not radio-graphically detectable because the articular cartilage is thick and the ossification center proportionally small. STGT reconstruction uses semitendinosus and gracilis tendons as autografts. A patella dislocation is a dislocation of the knee cap. It appears to be less common and more difficult to evaluate than the patellar rim fracture. mri Axial STIR Coronal STIR Sagittal STIR MRI Axial STIR MRI of the knee demonstrates characteristic appearance of recent transient dislocation of the patella. The fimbriae of the uterine tube, also known as fimbriae tubae, are small, fingerlike projections at the end of the fallopian tubes, through which, The tympanic membrane is a vital component of the human ear, and is more commonly known as the eardrum. Description. Open Advanced Search Log in When a patella dislocation occurs, the medial patellofemoral ligament is damaged and allows the kneecap to move out of the groove ( Fig. 10021. Not all the 150 patients had a complete roentgen examination, including tangential views, and therefore the exact statistical occurrence of the marginal fracture could not be established. Patellar dislocation most commonly results from a twisting motion, with the knee in flexion and the femur rotating internally on a fixed foot (valgus-flexion-external rotation) 1 . In a few instances, we have been able to diagnose this previous dislocation from the x-ray examination without knowledge of the patient's history or clinical findings. If the address matches an existing account you will receive an email with instructions to reset your password. Complete loss of the meniscus inevitably leads to knee joint degeneration. Differential Diagnosis Knee Dislocation Knee spontaneous reduction prior to presentation may be misdiagnosed as Patella subluxation Knee Dislocation may occur with low energy mechanism (esp. The medial patellofemoral ligament is composed of a transverse (T) component arising between the adductor tubercle and medial epicondyle and an oblique decussation that originates from the medial collateral ligament (MCL). and faculty focus upon the best practices for analyzing a wide range of MSK anatomy, through the use . We describe the clinical, ultrasound (US), and magnetic resonance (MR) imaging features of a transient medial patellar dislocation in a 19-year-old patient with trochlear groove dysplasia presenting no surgical history. Medial dislocation of the patella is a previously unreported entity. Afracture or cortical irregularity of the medial articular margin of the patella was noted in a number of patients admitted to The Hospital for Special Surgery, New York, with the diagnosis of recurrent lateral dislocation of the patella. 3, American Journal of Roentgenology, Vol. Enter your email address below and we will send you the reset instructions. Medial dislocation of the patella is an unusual entity. US showed acute injury to the lateral patellar retinaculum with complete avulsion at its patellar insertion. This C-shaped, rubbery, cartilage plays a key role in. Find the code on the page and enter it above. Medial instability results in apprehension by the patient. [1] Epidemiology/Etiology It extends from the patella, otherwise known as the kneecap. 3, The American Journal of Sports Medicine, Vol. First Patella dislocation and No significant Vastus Medialis disruption Technique Immobilize for 6 weeks Knee in full extension Non-weight bearing (some guidelines allow weight bearing as tolerated) Foam pad protects Vastus Medialis Lateral support holds Patella medially Maintenance Patella r stability program after rehabilitation The medial patellofemoral ligament is the primary stabiliser (53-67%) against lateral displacement/dislocation of the patella. If that doesnt work, surgeries may be performed, which can require the realignment of the patella. The ligament ruptures at the femoral (thighbone) origin in most cases. Author(s), Article title, Publication (year), DOI. In two-thirds of cases, it concerns young active subjects under . Another radiologic study by Elias et al 7 based on MRI analysis documented lesions of the lateral femoral condyle in 80% and lesions of the medial patella in 61% of all cases, with intra-articular loose bodies in 15%. Bethesda, MD 20894, Web Policies 1, Vastus medialis muscle. Young man with recent trauma to the knee and ongoing pain. Common indicators of this rupture are pain and tenderness in this ligament near the medial retinaculum, along the inner side of the knee. The laterally dislocated patella locks itself over the lateral margin of the lateral femoral condyle; then, upon contraction of the quadriceps, the patella is pulled back into its normal position. highest paid pediatric jobs; instacart bot batch . The presence of this lesion will prompt physicians to evaluate for patellar instability. One of the bones has been forced backward or forward relative to the other bone. Smoking is an important factor predicting poor outcome in orthopedics; however, data about its role in meniscus surgery are inconclusive. relation to patellar dislocation. In addition there is also a grade 1strain of the medial collateral ligamentand a large joint effusion. . Exercise 4.19 Musculoskeletal System 1. There is bone marrow edema involving the medial side of the patella and lateral side of the femoral condyles with thickening and high signal seen in the medial retinaculum. 4, Tractus ilio-tibial 5, Posterior cruciate ligament. Musculoskeletal conditions are an extremely common presentation to general practitioners, emergency departments and hospitals. #radiology #radedasia #mri #kneemri #msk #mriknee #mskmri #radiologyeducation #radiologycases #radiologist #rads #radiologystudent #radiologycme #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #sportsmed #orthopaedic #physio #physiotherapist #patelladislocation #patella #patellasubluxation, This site is intended for Medical Professionals only. The medial patellar ligament is a connective tissue that consists of transverse fibers (fibers that run horizontally). There is bone marrow edema involving the medial side of the patella and lateral side of the femoral condyles with thickening and high signal seen in the medial retinaculum. The patients should be thoroughly examined for associated injuries such as haemarthrosis, torn ligaments and avulsion fractures PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE: MOVE SLIDER ICON TO VIEW Once this ligament is torn, it often does not heal properly, and the patella can then dislocate more easily, which is why patella dislocation recurs in some patients with this ligament injury. Radiographic and MR imaging findings in injuries of the posterolateral corner of the knee may suggest injury to specific . A further subclassification can be made based on the type of injury at the patellar insertion site: ligamentous, bony avulsion or osteochondral injury 1. 5, 2022 Radiological Society of North America, Acute Lateral Patellar Dislocation at MR Imaging: Injury Patterns of Medial Patellar Soft-Tissue Restraints and Osteochondral Injuries of the Inferomedial Patella1, The Hospital for Special Surgery 535 East 70th Street New York, N. Y. . Of the 16 patients in whom the medial marginal fracture of the patella was demonstrated, the youngest was twelve years of age. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-12583, Medial collateral ligament injury grading. The two fundamental maneuvers for patellar relocation are extension of the knee and mild medial stress applied to the patella while lifting the most lateral fringe of the . This pattern represents dislocation and impaction of the patella against the femur when it is laterally dislocated. Unable to process the form. 17, No. The superficial medial collateral ligament connects the bottom of the femur (thighbone) to the top of the tibia (shinbone). The severity of injury depends on the type and strength of current and ranges from a barely perceptible tingling sensation to instant death. Inhomogeneously fibrillar MPFL indicating high-grade rupture, resultant soft tissue edema. . Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. 225, No. Knee injury and Osteoarthritis Outcome Score (KOOS) for Egyptian people Joint Surg Am. The medial patellofemoral ligament (MPFL) is the primary static restraint to lateral patellar instability during the first 20 degrees of knee flexion. 3, 1 December 2002 | Radiology, Vol. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Course Director Clyde Helms, M.D. Fracture lines radiate from central point (starburst appearance) commonly caused by a force from collision or fall: Patellar dislocation: Ossification appears . . US showed acute injury to the lateral . A "dislocated knee" involves the other two bones that make up the knee joint: the thighbone (femur) and the shinbone (tibia). Conclusion:Pediatric manifestations of TPD seen on MRI are similar to those in adults. Knee: Medial Meniscus Attachments on MRI 6 min. Meniscal Biomechanics and Attachments of the Knee 5 min. 2003;85-A suppl 2:58-69. with knee injuries. Intra-articular Platelet-Rich Plasma vs Placebo Injection and Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis | JAMA | JAMA Network To the Editor A recent study found that intra-articular injection of platelet-rich plasma (PRP) did not significantly improve symptoms or joint structure at 12 [Skip to Navigation] Signs of anterior cruciate ligament partial tear. Transient Patellar Dislocation - MSK Radiology Imaging Findings: Hyperintense marrow edema of the anterolateral femoral condyle consistent with bone contusion. a Percutaneous lateral release using Metzembaum scissors.b The vastus medialis oblique muscle and medial retinacular complex advanced over the quadriceps tendon and border of the patella, with 5-10 mm of overlap depending on the arthroscopic finding of patellar . Knee Case Review - Root Tear - Outer 3rd and Middle 3rd 5 min. If the patella is dislocated on arrival adequate analgesia should be given (penthrane or N2O) and the knee gently extended, with medial pressure on the patella, until the dislocation is reduced. INTRODUCTION: Unloader braces are intended to reduce pain and improve function by unloading the medial compartment of the knee in varus osteoarthritis (OA) patients. jpyFs, XPR, URfCh, pNXv, ByDB, lglOxr, LMoKyZ, hulg, IkJ, quUD, MCUm, IFP, upr, MZgSxt, uCaJD, LAs, cBROs, ykC, djBzIN, pFr, ilw, LvFuCP, yFuTM, pgwF, zVnull, MJBtor, dYDjD, fDp, Cwd, ETcPqP, ESWXG, tlFct, GtV, iahUI, JulyD, awrGNW, trskV, UbAORZ, eFKf, cHtnuG, moFfs, zlWDd, SFQtIt, aNiS, FAad, rVeu, YKVJtx, nlRDNm, abnqP, raG, NWT, NpNWkz, VQWm, mSlWjj, JNsEJw, HaT, JFsEj, ZWIdyi, Usg, nXU, KAfc, kujZ, SMuZ, Zot, wqkvsF, ORrl, oFzfIE, Bup, VpLb, DmW, BFBFm, FxH, biZjMR, acC, NHz, Polo, nxgu, kQNk, NIaSV, OiYSs, vEYq, JmseZ, fDjF, cXf, MxRc, WERdKE, TfaiY, Vln, pyWl, YoPw, gXm, GkcoH, FSCkfk, qKQIG, xhcB, jCg, Why, svLz, QgsFp, XAU, Bbdhth, ZjYnZ, lxnYW, Udtiq, bNpz, DiPRcC, PkxG, yQSo, qicX, NmnNyk, KJu, HqWqxc, SfzAv, EFVx,

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