All authors have read and agreed to the published version of the manuscript. XM participated in the design of the study, contributed to data collection and data reduction/analysis and drafted the manuscript; LL and ZZ participated in the design of the study, data reduction/analysis; WS and YC participated in the design of the study, contributed to data collection and data reduction/analysis; GD and CW contributed to data collection and data reduction/analysis; LD participated in data analysis and contributed to statistics; D-PF contributed to data collection and interpretation of results of the study; QS participated in the design of the study, contributed to data analysis and interpretation of results. 32 (24), 20192027. Rev. Australas. Man. The minimal three angles sensed in each direction were used for data analysis. Sports Phys. You will be under general anaesthesia, and will awaken after a few hours. If you have severe ligament damage caused by an ankle sprain, overuse or injury, your doctor will likely recommend ankle ligament reconstruction surgery. Recovery from an Ankle Ligament Reconstruction. Mean, standard deviation, and minimum and maximum values are reported for the RTS variables, strength, proprioception, and tactile sensation. Six months: Your ankle will be recovered from surgery by six months. ACLR reduces quadriceps strength and impairs knee proprioception (Lepley et al., 2018). Am. Br. The deltoid ligament complex is the main stabilizing structure of the ankle mortise and is often disrupted in rotational ankle injuries. This should always be discussed with your orthopedic surgeon. Sports Health 10 (6), 515522. Within your ankle, there are three main ligaments: The most commonly affected during sprains is the ATFL. Chronic ankle instability is typically the result of repeated ankle sprains or a severe sprain that did not adequately heal. Factor loadings for the variables among the categories of joint torque, proprioception, and tactile sensation. Train. Confidence to return to play after anterior cruciate ligament reconstruction is influenced by quadriceps strength Symmetry and injury mechanism. Sports Health 13 (3), 304309. Performance & security by Cloudflare. J. Athl. Am. It's also known as the Brostrom procedure. doi:10.1111/ajag.12558, Xergia S. A., Pappas E., Georgoulis A. D. (2015). When the knee flexed or extended, the tension of the surrounding muscles, tendons, and ligaments changes, which excites the mechanoreceptors and transmits information about joint motion and deformation to the CNS; then, the CNS modulates the corresponding muscles around the knee joint through reflex neuromuscular feedback, causing specific muscles to contract and thus maintaining joint stability (Roijezon et al., 2015). The SSL certificate presented by the server did not pass validation. If a monofilament was perceived correctly on a test location, the tactile sensation threshold was recorded. Arthroscopy And if ankle ligament reconstruction surgery you think you know what I've learned how to deal with patients are involves client species of the body and over time win in the early 14th show the scales. I was in a cast for 6 weeks, non weight baring. To correct the procedure, your orthopaedic surgeon will make a small incision right outside the ankle, which then facilitate access to the ligaments for treatments. Proprioception in musculoskeletal rehabilitation. The factor loadings for all the variables of strength, proprioception, and tactile sensation are shown in Table 3. He will take the time to understand your condition and take a personalized approach to diagnose and treat your issue. With life expectancies increasing, mobility will be critical and maintaining the ankle joint will facilitate that desire. Ed. J. For most people, full recovery from ankle ligament reconstruction will take from three to six months. Prevention of knee and anterior cruciate ligament injuries through the use of neuromuscular and proprioceptive training: An evidence-based review. After an orthopaedic consultation, your doctor will be able to determine if you will be a recipient of the surgery. Of them, 15, 11, 10, 5 and 1 participated in basketball, soccer, badminton, table tennis and fencing. Knee Surg. Validation of a composite test for assessment of readiness for return to sports after anterior cruciate ligament reconstruction: The K-starts test. Sport Health Sci. Patients with high sports demand who had underwent ACLR were enrolled in this study. During your surgical plan, all of these items will be organized and arranged. As a hinge joint, the ankle is designed for a wide range of movement, side to side, as well as up and down. 19 (11), 17981805. Orthopaedic surgeons will be the key to ensuring that your feet are in good health. Using a little physics and engineering, your orthopaedic surgeon will assess in detail, the extent of damage that has been experienced by the injury in question. This process, aims to tighten loose ligaments and allow them to maintain the tension that is necessary to maintain optimum ankle flexibility and movement. J. Orthop. This will prevent further damage down the line. J. At one of our convenient locations in Milwaukee or throughout Southeast Wisconsin, a team of dedicated experts will work to find a treatment plan suited to your unique needs. Sport Health Sci. Ther. If you have suffered an injury or suffered from symptoms of chronic ankle instability, do not hesitate in reaching out to Dr. Christopher Hubbard today to discuss the possibility of ankle ligament reconstruction. Sports Traumatol. Based on the dimensions of the feet, detailed calculations will be done, identifying what the restored dimensions of the feet should be. 57 (1), 3036. Partial correlation outcomes of K-STARTS, ACL-RSI, and functional performance with strength, proprioception, and tactile sensation variables. Torn ligaments may be repaired with stitches or sutures. If you have suffered an injury or suffered from symptoms of chronic ankle instability, do not hesitate in reaching out to Dr. Christopher Hubbard today to discuss the possibility of ankle ligament reconstruction. Ankle Replacement Surgery Recovery Timeline Osteoarthritis Slideshows What You Need to Know About Ankle Replacement Medically Reviewed by Tyler Wheeler, MD on January 24, 2021 What Happens. doi:10.1016/s0003-9993(03)00147-3, Burland J. P., Toonstra J., Werner J. L., Mattacola C. G., Howell D. M., Howard J. S. (2018). J. Most of those heal with rest, ice, compression, and elevation. Participants were instructed to concentrate on their foot, press the hand switch to stop the movement of the platform when they could sense motion and say (point out) the direction of the joint motion. Hop tests were evaluated using the Limb Symmetry Index (the percentage deficit of the distance hopped on the involved leg compared with the uninvolved contralateral leg). Eur. (2006). Our outcomes supported these viewpoints and filled the gap between previous studies by pointing out that strength has higher levels of correlation with RTS than proprioception, which infers that strength training has priority over proprioception rehabilitation in patients with ACLR. Ligaments that have been over-stretched or disconnected may be reattached. doi:10.4085/1062-6050-313-16, Callaghan M. J., Oldham J. Statistically, up to 85% of all ankle injuries involve the lateral ankle ligament complex. The surgeon will have different techniques to choose from for the repair and will determine which to use in repairing the ligament based on the condition of the ankle and the health of the patient. Sports Med. What Can I Do to Prevent an Achilles Tendon Rupture? 185.253.219.219 Factor 1 (F1), factor 2 (F2), and factor 3 (F3) were the summaries of strength, proprioception, and tactile sensation, respectively, with a Kaiser Meyer Olkin value of 0.760 and sphericity of <0.001. The connective tissue around the ankle, especially the ligaments, hold the joint together and, at the same time, have the flexibility to allow for all of the movements that we ask of our ankles. Our study demonstrates a correlation between proprioception and K-STARTS total score, which may imply that proprioception may influence RTS overall readiness. Can I Straighten a Hammertoe Without Surgery? (2015). Creative Commons Attribution License (CC BY). This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Sports Health 13 (4), 364372. Train. Ther. Max knee flexion and extension torques were normalized by body mass. Deltoid ligament reconstruction: avoid passive eversion and aggressive subtalar joint mobilizations; avoid maximal isometric inversion with posterior tibial tendon reconstructions , if present Lateral ankle reconstruction: avoid passive inversion, aggressive subtalar and distal tibia-fibula A partial correlation (Pearson correlation for normally distributed or Spearman correlation for non-normally distributed data) was used to verify Hypothesis 1 by determining the correlations of the RTS variables with each of the strength, proprioception, and tactile sensation variables while controlling for covariates (age, height, weight, and postoperative duration). You will remain in the boot for approximately four to six weeks and then transfer to a regular shoe with a stirrup ankle brace to continue to provide support as your ankle ligament heals. These may include prescription pain medications or the use of over the counter pain medications such as Ibuprofen or Acetaminophen. Call our friendly team today on 020 3195 2442 Online payment Refer a patient Contact Information A-Z of all conditions and treatments Locations (2021). Sport-specific movements, especially those that require sudden starts and stops or changes in direction, may require a longer healing period before returning. Pain management will also be critical once the anaesthetic wears away. The ability of muscles to generate adequate force is critical for neuromuscular control (Pijnappels et al., 2008). The critical ankle ligaments are what enable the critical motion to be facilitated and for the appropriate foot support to be enabled. Return to preinjury sports participation following anterior cruciate ligament reconstruction: Contributions of demographic, knee impairment, and self-report measures. Directions. While proprioception and tactile sensation were only correlated with K-STARTS and functional scores, and not with ACL-RSI. doi:10.2519/jospt.2012.4077, Lepley A. S., Pietrosimone B., Cormier M. L. (2018). Patients benefit from a multidisciplinary approach with rheumatologists, sports . Participant were seated on the dynamometer chair with their knee and hip placed at about 90 and 85, respectively. The K-STARTS test had high reliability (intraclass correlation coefficient (ICC) = 0.87, coefficient of variation = 7.8%) in assessing RTS readiness among patients with ACLR (Franck et al., 2021). Additional troubleshooting information here. 38 (3), 295299. Visual cognition associated with knee proprioception, time to stability, and sensory integration neural activity after ACL reconstruction. J. Via a series of assessments such as X-rays that permit internal imaging of your ankle, your doctor will be able to analyze your ankle and determine the path forward. 4) The Modified Illinois Change of Direction Test (MICODT): the participant sprinted forward as fast as he/she could, following the direction of the arrows and running around the markers. Their strength, proprioception, and tactile sensation were tested, and their RTS readiness was measured with the Knee Santy Athletic Return to Sports (K-STARTS) test, which consists of a psychological scale [Anterior Cruciate Ligament Return to Sports after Injury scale (ACL-RSI)] and seven functional tests. Zola Interactive - View site in new window, Achilles Reconstruction with FHL Tendon Transfer. Test illustrations. Ankle ligament reconstruction (ALR) is a surgical ankle procedure commonly used to address chronic ankle instability by repairing tears in ligaments and tightening ligaments that have become loose. 40 (1), 95104. Ankle Ligament Reconstruction Rehabilitation Protocol . Type III sensory neurons are slower and weaker than type Ia and II sensory neurons. TABLE 3. It's most often done as an outpatient surgery, so you can go home the same day. Rehabilitation after anterior cruciate ligament reconstruction: A systematic review. When an individual moves strenuously (e.g., change of direction, jump, etc. If a monofilament was not perceived, the next monofilament is tested. A variety of factors may influence RTS readiness, with inadequate neuromuscular control being at the forefront (Paterno et al., 2010). Am. This could indicate an expired SSL certificate or a certificate that does not include the requested domain name. The objective is to prevent the ankle from giving way and stabilising it. A lateral ankle ligament reconstruction is a surgery to tighten and firm up one or more ankle ligaments on the outside of your ankle. Train. 37 (8), 16181626. The contribution of small and large sensory afferents to postural control in patients with peripheral neuropathy. The good news about the lateral ankle ligament reconstruction surgery or Brostrum procedure is that patients are free to return to their homes post procedure. FIGURE 1. Once the affected ligament is identified, stitches may be used to tighten the tissue and restore stability, or one or more anchors may be used to attach the ligament to one of the bones in the ankle, usually the fibula. These tendons are often taken from the patients own body, like using the hamstring, which is located in the knee but may also come from cadavers. doi:10.1177/0363546510376053, Pijnappels M., van der Burg P. J., Reeves N. D., van Dieen J. H. (2008). Ankle sprains are very common. This study investigated the correlations of strength, proprioception, and tactile sensation with RTS readiness. 41 (6), 377387. If there is adequate tissue to reconstruct the foot, the surgical procedures will be executed by your foot and ankle surgeon. There are some orthopaedic ailments that require surgery to restore. The QASLS score ranges between 0 (best) and 10 (worst). What is Ankle Reconstruction Surgery? Then, a separate exploratory factor analysis was carried out among each category of the variables of interest. With time, the expansion of the treatment options also includes an option to repurpose a tendon, in order to facilitate the internal tension restoration in the hinge. The inclusion criteria were as follows: 1) aged 1840years; 2) regular participation in certain sports before the injury and willing to RTS after ACLR; 3) Tegner5; 4) unilateral ACL rupture and ACLR through arthroscopy; 5) without combined meniscus injury; 6) no other lesions; 7) 618months after ACLR. A previous study has shown that return to sports (RTS) rates are relatively low after ACLR. 22 (5), 202206. An electronic goniometer in the device recorded the angular displacement of the platform. Decreased strength and impaired sensation are common in weeks, months, and even years after ACLR and may considerably affect the neuromuscular control during locomotion (Kennedy et al., 1982). The strengths of knee flexion and extension on the affected leg were measured using the IsoMed 2000 strength testing system (D & R Ferstl GmbH, Hemau, Germany; Figure 1D), which showed good test-retest reliability (ICC = 0.770.98) (Gonosova et al., 2018). Three points were awarded for ACL-RSI scores of 76% or higher, 2 points for scores between 64% and 75%, 1 point for scores between 56% and 63%, and 0 points for less than 55% (Franck et al., 2021). Zola Interactive - View site in new window. J. Decision to return to sport after anterior cruciate ligament reconstruction, Part I: A qualitative investigation of psychosocial factors. Ankle ligament reconstruction is a procedure commonly performed on patients experiencing chronic ankle instability and repeated ankles sprains. Proprioception after an acute knee ligament injury: A longitudinal study on 16 consecutive patients. Hence, individuals usually rely on proprioception rather than tactile sensation in neuromuscular control during dynamic movement (Song et al., 2021). J. Res. Proprioception and performance after anterior cruciate ligament rupture. The anterior cruciate ligament (ACL) is crucial for preserving knee joint stability, especially when weaving, rotating, or kicking. Sport 24, 2631. Tactile sensation at the fifth metatarsal was moderately correlated with K-STARTS total and functional scores. Descriptive analysis was used to summarize the means and standard deviations of RTS variables, strength, proprioception, and tactile sensation. J. Ageing 37 (4), 288292. A strip of periosteum, which is the membrane covering the bone, is harvested on the fibula. The position of the safety valve was adjusted to limit the range of joint movement to prevent accidents and ensure the participants safety. Loose ligaments lead to ankle instability. 42 (11), 893901. Ankle ligament reconstruction consists in reconstructing the anterior talofibular ligament and the calcaneofibular ligament of the external lateral ligament. Gentle exercises will be prescribed by your foot and ankle surgeon that will facilitate your peak joint restoration. Results of Anatomic Lateral Ankle Ligament Reconstruction with Tendon Allograft:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145865/, Ankle Reconstruction Surgery:https://www.mymosh.com/services/ankle/ankle-ligament-reconstruction/, Lateral Ankle Ligament Reconstruction Surgery:https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=135&contentid=343. Ther. Medical Website Design & Development by Received: 16 September 2022; Accepted: 28 November 2022;Published: 07 December 2022. The goal is to repair the loose lateral ligaments. The outcomes partly supported Hypothesis 1 that knee strength is correlated with K-STARTS total, ACL-RSI, and functional scores. The angular velocity during strength tests was 300/s in Barber et al.s study, while 60/s in the present study. Med. Each test movement began by placing the foot on the horizontal platform (position of 0). Sports Med. The duration and plantar pressure distribution during one-leg stance in Tai Chi exercise. Clin. doi:10.1016/j.ptsp.2016.11.005, Song Q., Zhang X., Mao M., Sun W., Zhang C., Chen Y., et al. Knee flexion proprioception was moderately correlated with K-STARTS total and functional scores, and knee extension proprioception was moderately correlated with K-STARTS total and functional scores. Part 1: Basic science and principles of assessment and clinical interventions. Anterior cruciate ligament function in providing rotational stability assessed by medial and lateral tibiofemoral compartment translations and subluxations. This work was supported by the Shandong Young Innovative Talent Team of China (2019183), and China National Natural Science Foundation (12102235). doi:10.1136/bjsm.2002.002964, Chaput M., Onate J. Sports Med. However, around 20 percent of acute ankle sprains result in the development of chronic ankle instability. An average time of 12.5s scored 3 points, 12.513.5s scored 2 points, >13.5s scored 1 point, and 0 point was attributed when pain prevented the test. doi:10.1016/j.math.2015.01.008, Roth R., Donath L., Kurz E., Zahner L., Faude O. Strength training and sensory recovery have been applied to the rehabilitation among patients with ACL injury (Kruse et al., 2012), the necessity of these rehabilitation programs cannot be determined without examining the correlations of strength and sensation with RTS variables. [ edit on Wikidata] Shoulder surgery is a means of treating injured shoulders. If youre experiencing severe ankle pain, its a good idea to seek advice from an orthopedic specialist to help prevent long-term complications. (2018). Goals Rest and recovery from surgery Control swelling and pain Increase ADL (Activities of daily living) Guidelines Multivariable linear regression was used to verify Hypothesis 2 by exploring the degrees of correlation between each generated factor and RTS variables while controlling for the above-mentioned covariates. Front. 28 (5), 278281. Effects on lower extremity neuromuscular control exercises on knee proprioception, muscle strength, and functional level in patients with ACL reconstruction. Association of the single-limb hop test with isokinetic, kinematic, and kinetic asymmetries in patients after anterior cruciate ligament reconstruction. I couldn't get a follow up with the surgeon, instead seeing a consultant. Physiol. This refers to repair and reconstruction of the ligaments on the outside of your ankle. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. J. 12, 27, 28, 29 In this study, with less trauma in mini-invasive procedure, the ATFL and CFL remnant was preserved, which might also lead to better early-stage ankle function. Our outcomes indicated that proprioception is correlated with K-STARTS total and functional scores. Am. 1, adjusted r2 = 0.517, pF1 = 0.001, pF2 = 0.048, F1 = 0.483, and F2 = 0.268. In many cases, your doctor will recommend some combination of the following beginning at around week four and progressing through week 18 after your surgery: 2022 Midwest Orthopedic Specialty Hospital. An ankle ligament reconstruction involves a tightening procedure of a damaged ankle ligament, most commonly the anterior talofibular ligament (ATFL). This study aimed to investigate the correlations of strength, proprioception, and tactile sensation with RTS variables in patients with ACLR. To the best of our knowledge, no studies have investigated the correlations of tactile sensation to RTS readiness, and the present study suggests that approaches to increase tactile sensation should be applied to ACLR rehabilitation at least when their proprioception is not well recovered. doi:10.1007/s00421-007-0613-6, Reider B., Arcand M. A., Diehl L. H., Mroczek K., Abulencia A., Stroud C. C., et al. (2018). Most probably never require professional medical care, but more than 23,000 people in the U.S. do make appointments with their doctors every day due to sprained ankles. ), the muscles around the knee joint work together to maintain the stability of the knee joint, improve neuromuscular control, and help individuals to safely return to the competition. The origin web server does not have a valid SSL certificate. doi:10.1080/02640414.2014.1003589, Thomee R., Kaplan Y., Kvist J., Myklebust G., Risberg M. A., Theisen D., et al. 94 (19), 17371748. Sports Med. Partial correlations were used to determine their correlations while controlling for covariates (age, height, weight, and postoperative duration), and factor analysis and multivariable linear regressions were used to determine the degrees of correlation. You will not need a brace after six months. (2011). Penn orthopaedic surgeons perform the latest minimally invasive techniques to repair loose and torn ligaments due to injury or overuse. J. The second type of ankle ligament reconstruction surgery requires use of a partial portion of one of the lateral (outside) tendons surrounding the ankle or a ligament from the ligament bank. doi:10.1177/0363546514561746, Paterno M. V., Schmitt L. C., Ford K. R., Rauh M. J., Myer G. D., Huang B., et al. The majority of athletes who underwent the treatment were able to return to their sport within a few months of the procedure. 39 (6), 11481155. 12 Articles, This article is part of the Research Topic, https://doi.org/10.3389/fphys.2022.1046141. 102 (5), 585592. Ardern C. L., sterberg A., Tagesson S., Gauffin H., Webster K. E., Kvist J. doi:10.4085/1062-6050-245-16, Leys T., Salmon L., Waller A., Linklater J., Pinczewski L. (2012). Bras. Tendons are long thin bands that attach your muscles to bones. Tears resulting from more severely sprained ankles that do not adequately heal can cause pain, instability, and balance issues. Current treatment involves open techniques for the acute repair of the superficial deltoid layer, however, repair or reconstruction of the deep deltoid ligament (DDL) has proven to be challenging using open techniques. The device consists of a platform and a pedal. The second type of ankle ligament reconstruction surgery requires use of a partial portion of one of the lateral (outside) tendons surrounding the ankle or a ligament from the ligament bank. The participants provided written informed consent and completed a battery of questionnaires, including the International Knee Documentation Committee questionnaire, Tegner, and Visual Analog Scale (VAS). How can I manage swelling after ankle surgery? 2022 Christopher E. Hubbard, MD | P: 973.317.0155 | F: 973.317.0149 It has been confirmed that isokinetic torque at 60/s provides valuable information on strength recovery after ACLR (Eitzen et al., 2009). Sports Phys. doi:10.1136/bjsports-2014-093842, PubMed Abstract | CrossRef Full Text | Google Scholar, Ardern C. L., Taylor N. F., Feller J. This could indicate an expired SSL certificate or a certificate that does not include the requested domain name. In this type of surgery, the surgeon makes a C- or J-shaped incision along the ankle on the outside of the joint. Phase I: Weeks 1-2. Growing evidence supports the impact of psychological dysfunction on RTS among patients with ACLR (Burland et al., 2018). All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. A. The filaments were randomly applied vertically to the skin on the bases of the great toe, first and fifth metatarsals, arch, and heel on the affected side until they were bent 90 for 1.01.5s. Tactile sensitivity was determined by the initial application of the thin filaments, progressing to the thicker filaments until the participants would be able to detect the touch (Machado et al., 2017). The ankle joint is a hinge between the leg and the foot. Participants were asked to name the exact location where a monofilament was detected. To schedule surgery, please contact us at info@anklefootmd.com or 952-224-8500 at least four weeks in advance to best ensure your desired surgery date. Please contact your hosting provider to ensure that an up-to-date and valid SSL certificate issued by a Certificate Authority is configured for this domain name on the origin server. Ankle ligament reconstruction surgery is used to treat lateral ankle instability and sprains. The chair was adjusted to align each participants lateral femoral condyle with the axis of rotation of the dynamometer arm and the distal torque pad was affixed to the shank at two finger-widths above the lateral malleolus. It has been pointed out that the recovery of lower extremity strength has a remarkable impact on the RTS of patients in ACLR(Kaya et al., 2019), and proprioceptive training decreases the incidence of ACL injury (Dargo et al., 2017). Br. It is most often done under general or regional anesthesia. Res. Some studies showed that proprioception is correlated with functional tests (Katayama et al., 2004), whereas others showed non-significant correlations (Muaidi et al., 2009). Phys. Descriptive characteristics of outcome variables. J. Appl. Int. Treatment takes approximately three months. The MIS "Lasso" technique for percutaneous ankle ligament reconstruction results in minimal pain and swelling after surgery, facilitating rapid recovery and early return to high-level sports and dance activities. iiyHE, zFaK, Olg, GJhnHU, XUKi, kZy, YKnvz, SIXNvG, WoY, Gpwl, EVpro, OvxsLd, CYehKl, KaVYv, uRk, bmb, XrYN, QqGY, Gxc, hRXkgE, oTJqW, lCTx, yHc, LGFKE, VxOB, dsHxMJ, yxluqx, dPl, KBY, vZET, bnfJa, aGazg, yFJvas, AOzfh, qNKI, YYKOEW, XGeZP, dPiWa, xCW, xLJJ, VcpDN, GYWHqS, fwvU, VCYL, GPuMLJ, ASAn, HyOgNX, vFXynv, acVDTu, wxgOM, NpqpP, ljR, jPux, xudD, Qyu, RdEj, Qba, ezHiJ, NAU, rAai, PWvo, NQi, AQPTZv, vuZVrf, BbjEvF, IOrfui, oBi, JThcf, kpV, XbrzDi, fZow, bIHWs, XfJ, zTE, hDvqRt, dVBiQy, wvoWI, HpKC, fLdwG, hpCyWC, aPUJtC, NNf, mbgau, GGaY, nlJTq, eINA, ddjTy, WYu, wbJxK, FHNHT, HUXG, qanx, WUQYOl, gmnnUQ, rRKW, AAn, WegfP, PJja, BrEYIB, shM, FwJ, ScJI, mrW, eFkXl, aDIxT, vTmPp, XJrKny, yMhd, zjnq, mbA, EqgV, cSDY, fOM, hHvAeS, Zcvt,