Through the analysis of Javelin throwers' injuries in sports, this paper uses the biomechanical analysis method to analyze the changes of data in the final exertion stage and the related reasons. Baillie P, Ferrar K, Cook J, Smith P, Lam J, Mayes S. Clin J Sport Med. Failure of fusion results in an ossicle called an os trigonum (Fig. Ankle impingement syndromes are important causes of persistent ankle pain. Posterior ankle impingement is typically seen in athletes, primarily dancers and soccer players, secondary to dynamic and repetitive push-off maneuvers and forced hyperplantarflexion. Ankle ROM was significantly improved from an average of 24.8 (10-35) preoperatively to 58.0 (50-65) at 3 months postoperatively and to 64.0 (50-65) at 1 year and 64.7 (60-65) at 2 years postoperatively. The question was addressed in three ways: (1) a query of Kids' Inpatient Database (KID) to obtain nationally representative data; (2) retrospective review of cases at a single institution; (3) survey of Scoliosis Research Society (SRS) spine surgeons. trigonum can develop after disruption of the os trigonum through a Hayashi D, Roemer FW, DHooghe P, Guermazi A. Posterior ankle impingement in athletes: pathogenesis, imaging features and differential diagnoses, Os trigonum excision in dancers via an open posteromedial approach, Endoscopic flexor hallucis longus decompression: a cadaver study, Fracture of the os trigonum: a case report, Symptomatic radiographic variants in extremities. 13, Fig. PAIS can be the result of an acute injury of the ankle, which is more often in general population, or it can be the result of the overuse syndrome, which is more often in athletes and ballet dancers. Jaydev Dave, PhD, Associate Professor of Radiology at Thomas, MarketScale's Made in America series explores industries that are thriving in the USA. An experience of 26 cases was required to be proficient in posterior arthroscopies. Posterior ankle impingement syndrome is a clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. Scholten PE, Altena MC, Krips R, van Dijk CN. Acta orthopaedica et traumatologica turcica. Posterior Ankle Impingement Syndrome Clinical Features Are Not Associated With Imaging Findings in Elite Ballet Dancers and Athletes. J Am Acad Orthop Surg. patchy-marrow edema can appear throughout the hind foot.8 MR imaging can reveal fracture through the os trigonum or fluid in synchondrosis, indicating os trigonum fracture. Posterior-ankle impingement syndrome due to os trigonum syndrome. The local ethics committee of the Central Clinic of Athens (Orthopaedic Research Institute for Education and Training) approved the study, which was carried out according to the World Medical Association Declaration of Helsinki. Local anesthetic injection can also help confirm the diagnosis and can combined with a corticosteroid for treatment purposes. This represented an os trigonum (accessory bone). eCollection 2020. MR imaging. Multimodality imaging including radiography, CT, ultrasound and MRI is useful for assessing the structural correlates of ankle impingement. Fourteen patients returned to their preinjury level of athletics. Similarly, Noguchi et al reported subtalar arthroscopic resection of bony impingement in the lateral decubitus position, on 12 young athletes, with statistically significant improvement of AOFAS score and ROM. Differential diagnosis and operative treatment. They recommend the use of posterior endoscopy for patients with an OS >135 mm2 and for those with concomitant FHL tendinitis or other posterior ankle conditions. The results showed that the injury constituent ratio of 50 national and elite javelin throwers was investigated. In Routine anteroposterior (AP) ankle view typically do not reveal abnormalities related to posterior impingement. Do We Need Postoperative Chest Radiographs After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis? Smith fractures, also known as Goyrand fractures in the French literature 3, are fractures of the distal radius with associated volar angulation of the distal fracture fragment(s). Baseline quadriceps ACSA and extensor (specific) strength represented the primary analytic focus, and 2-year changes of quadriceps ACSAs the secondary focus. 23,25,34,42,43 Lateral radiographs obtained 2222-2230, Osteoarthritis and Cartilage, Volume 22, Issue 10, 2014, pp. Plantar fasciitis with calcaneal enthesopathy, as a result of either repetitive trauma or a seronegative spondyloarthropathy, can produce plantar calcaneal bone marrow edema. The frequency of PTX and surgical intervention were recorded. Studies have shown that athletes in the final stage of the force of the javelin shot, the left leg to stretch and stretch may be an important factor in the damage. Federal government websites often end in .gov or .mil. Abbreviations: BMI, body mass index; OT, os trigonum. Routine postoperative chest radiographs are of questionable value after PSIF for AIS. But if it fails to fuse, an os In it's, The medtech landscape is constantly evolving. Also, in all cases, the patients had received conservative therapy for a period of 4-6 months and had received at least 1 local injection of steroids. Furthermore, with regard to operative complications, there were 4 transient complications: 1 woman with 2 months of drainage at the medial portal due to fat pad atrophy and skin healing issues after 2 local injections of cortisone the last 4 months before operation and 3 additional transient sural nerve neurapraxia. The posterior intermalleolar ligament may protrude further into the joint during plantar flexion, becoming entrapped and torn. Posterior Ankle Mobility This mobilization exercise keeps the tibia in an optimal position as you bend the ankle. Treatment can be either operative or non-operative and is dependent on the type of fracture (as determined by the x-ray). With axial traction, joint space width increased significantly and delineation of cartilage surfaces was rated superior (P<0.05). 1548-1553, Spine Deformity, Volume 7, Issue 4, 2019, pp. These include edema or enhancement of posterior soft tissue, These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. In athletes presenting with posterior ankle impingement symptoms, radiologists should pay specific attention to the presence of os trigonum, Stieda process (posteriolateral talar process) (Fig. Lunate dislocations are an uncommon traumatic wrist injury that require prompt management and surgical repair. The two main components of the Preliminary approximations of what the future burden of related rheumatic disease in the region as a consequence of CHIK infection for 20152016 could be could be, given the timeframe of median time of occurrence are presented. The patients began a return to their activity after a minimum of 8 weeks, and all of them were back within a maximum of 12 weeks (mean 9.1 weeks). Radiology report. belly due to impingement.8, An os trigonum should be Peace KA, Hillier JC, Hulme A, Healy JC. performed with a high-resolution surface coil on a 1.5-tesla (T) 14). 47 J Am Acad Orthop Surg. Magnetic resonance imaging findings associated with posterior ankle impingement syndrome are prevalent in elite ballet dancers and athletes. Before The diagnosis of PAIS was based primarily on a history of posterior ankle and hindfoot pain and the physical examination. In addition, the mean operative time and the time to return to sport were similar for both groups. The os trigonum syndrome: Imaging features. In ballet dancers, it has a reported prevalence of 30%, which may be attributed to repetitive forced plantarflexion in ballet training during the skeletal maturation phase of development that precedes the closure of the ossification center. Radiographs were reported to be normal in 37/52 (71%) ankles, while MRI report did not mention the diagnosis in 20/41 (49%) studies. The os trigonum was lifted from the subtalar joint by means of a small-sized bone elevator and removed finally with a grasper. The prevalence of pCHIK chronic polyarthralgia (pCHIK-CPA) is detailed in patients that suffered from confirmed CHIK at least 6 weeks before current assessment with a maximum follow-up of 65 weeks (15 months) (median time of 35 weeks). Focal marrow edema signal of the medial talar dome is seen with hypointense T1 and hyperintense T2 and STIR signal with likely small osteochondral lesion. 13 By continuing you agree to the use of cookies. Normally,this ossification center fuses 8600 Rockville Pike We use cookies to help provide and enhance our service and tailor content and ads. Posterior talar bone marrow edema is typically caused by posterior impingement secondary to a prominent os trigonum or Stieda process . An official website of the United States government. A sterile compression dressing was applied. All patients underwent an endoscopic approach in the treatment of OT PAIS, based on the technique described in detail by van Dijk. Bureau NJ, Cardinal E, Hobden R, Aubin B. Posterior ankle impingement syndrome: MR imaging findings in seven patients. (C) Release of flexor hallucis longus tendon with flexor retinaculum. Furthermore, Carreira et al presented the results of 20 patients who underwent arthroscopic treatment for OT, tibial exostosis, talar exostosis, loose body or fracture nonunion, and ganglion cyst removal, and were followed up with prospectively at a mean of 38.2 months. The learning curve of the posterior ankle arthroscopy was detected and determined by a logarithmic trendline and moving averages. At the final follow-up, VAS pain and AOFAS hindfoot scores showed significant improvement (P < .01) pre- to postoperatively. 1,3,6,21,24 It does not store any personal data. Conservative treatment ranging from 6 weeks to 3 months was required of all our patients (rest, cessation of activity, technique modification, nonsteroidal anti-inflammatory agents, ice, physical therapy, injections, and immobilization). The authors concluded that both techniques are safe and effective, but that subtalar arthroscopy is more challenging. 3, 20, 24 All patients completed a conservative therapy period of a minimum of 3 months, which included rest, anti-inflammatory medication, controlled ankle motion boot, and physical therapy. flexion of the foot, such as soccer, basketball, and volleyball, as well Only 5 patients dropped to a lower activity level. Isometric extensor and flexor muscle strength were measured (Good Strength Chair). Most of these conditions (excluding fractures) should initially be treated conservatively; but should these measures fail, or if dealing with high performance young athletes, operative treatment should be considered. Routine postoperative chest radiography after PSIF for AIS is performed in many institutions to evaluate for acute pulmonary complications, particularly pneumothorax (PTX). Outcome and Complications of Studies: Arthroscopic Procedure of PAIS. The MRI features supportive of impingement may be present in asymptomatic individuals and therefore accurate diagnosis requires careful clinical correlation. Posterior-ankle impingement (PAI) syndrome describes a group of pathological entities that result from repetitive plantar flexion of the foot that causes repeated compression and entrapment of soft tissues, bony processes or unfused ossicles between the posterior-tibial plafond and the superior surface of the calcaneum. SRS respondents reported a PTX risk of 0.8% (87/11,318), and 32.2% (89/276) of respondents indicated routine use of postoperative chest radiographs. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. It is especially important for the orthopedic surgeon to assess preoperatively in which of these 3 categories the patient belongs, in order to properly treat the problem. determination of the exact nature of the osseous- and soft-tissue These cookies track visitors across websites and collect information to provide customized ads. Over the last 2 decades, posterior arthroscopy (PA) of the ankle improved considerably and became an excellent procedure, as a safe and reliable treatment option for different pathologies of the ankle and hindfoot. One of the main etiologies for posterior ankle impingement syndrome (PAIS) pain is OT pathology, often due to an acute or chronic fracture. After removal of the Kager fat pad, fibrous tissue, and the thin joint capsule, the ankle joint was accessed and inspected. weight-bearing immobilization, and physiotherapy. Patients with PTX had, on average, an increased number of vertebrae fused (p = .012), a proximal thoracic scoliosis curve location (p = .009), and/or an intraoperative blood transfusion (p = .002). The aims of this pictorial review article is to describe different types of posterior ankle impingement due to traumatic and non-traumatic osseous and soft tissue pathology in athletes, to describe diagnostic imaging strategies of these pathologies, and illustrate their imaging features, including relevant differential diagnoses. Le Fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base.In order to be separated from the skull base, the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid bone dorsally. FOIA Abbreviations: Postop, postoperative; Preop, preoperative; VAS, visual analog scale. Ill-defined hyperintense signal was seen in the soft tissue around the described the use of posterior hindfoot endoscopy with posteromedial and posterolateral portals for OT resection with minimal complications with hastened return to sports. Physical therapy, nonsteroidal anti-inflammatory medication, and corticosteroid injection were administered without significant improvement. On the lateral view, a prominent Stiedas process or os trigonum may be identified in the posterolateral aspect of the ankle. de Leeuw PAJ, van Sterkenburg MN, van Dijk CN. PMC legacy view Abbreviations: FADI, Foot & Ankle Disability Index; Postop, postoperative; Preop, preoperative. Classically, these fractures are extra-articular transverse fractures and can be thought of as a reverse Colles fracture.. Keeping up with those changes to maintain accreditation standards, Key Points: Up to 20% of subtle Lisfranc injuries are missed on initial plain films., Medical imaging companies CurveBeam, LLC and StraxCorp, Ltd., announced today. The posterior ankle arthroscopy was minimally invasive, safe, and effective for treatment of bony PAIS, offering a quick recovery and allowing for a prompt return to a preinjury activity. Can imaging criteria distinguish enchondroma from grade 1 chondrosarcoma? Bureau NJ, Cardinal E, Hobden R, Aubin B. Posterior ankle impingement syndrome: MR imaging findings in seven patients, Return to training and playing after posterior ankle arthroscopy for posterior impingement in elite professional soccer, Outcome of arthroscopic treatment of posterior impingement of the ankle. and 8 and 10 years in girls. These are unusual causes of posterior ankle impingement. Case Rep Orthop. To help differentiate deltoid ligament deficiency from posterior tibial dysfunction as the cause of malalignment, the patient is asked to toe-rise. The posterior talofibular ligament also appears mildly thickened with intermediate T1 and T2 signal intensity. cartilaginous synchondrosis disruption, os trigonum fracture, or an avulsion injury of the posterior talofibular ligament. The correct diagnosis of enchondroma was made on radiographs in 43 (67.2%) of readings, and on MRI in 37/64 (57.8%). 32 If conservative The cookie is used to store the user consent for the cookies in the category "Analytics". Dr. Guermazi received consultancies, speaking fees, and/or honoraria from Merck Serono, Tissue Gene, and OrthoTrophix, and is the President of Boston Imaging Core Lab (BICL), a company providing image assessment services. AOFAS and FADI scores were significantly improved from 39.4 (18-55) and 49.7 (42.3-62.5) preoperatively to 85.2 (74-89) and 87.3 (81.7-88.5) postoperatively at 3 months to 97.7 (85-100) and 97.9 (93.3-100) postoperatively at 1 year, respectively (P < .001). Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. When done correctly, you should notice immediate results with more pain free ankle range of motion. calcaneal tuberosity.3 MR imaging is the modality of choice Rosenberg Careers. Endoscopic treatment of PAIS due to OT pathology demonstrated excellent results. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". on 186 patients (only 34 of all for PAIS) where OT excision were performed with/without FHL tenolysis. To compare cross-sectional and longitudinal side-differences in thigh muscle anatomical cross-sectional areas (ACSAs), muscle strength, and specific strength (strength/ACSA), between knees with early radiographic change vs knees without radiographic knee osteoarthritis (RKOA), in the same person. pseudoarthrosis). To report mid-term clinical results of posterior ankle arthroscopy in the treatment of posterior ankle impingement syndrome (PAIS) and to assess the learning curve and its influence on the results. Through exercise, the joint mobility and range of motion may gradually increase, progressively reducing the distance between the calcaneus and the posterior portion of the distal tibia [4]. Kappa coefficients, sensitivity, specificity, and differences in percentage agreement or correct diagnosis (p-value, McNemars test) were calculated per lesion and overall per 7 lesion types to assess whether diagnostic reproducibility and accuracy was improved. The aims of this pictorial review article are to describe different types of posterior ankle impingement due to traumatic and non-traumatic osseous and soft tissue pathology, and to describe diagnostic imaging strategies of these pathologies and illustrate their imaging features, including relevant differential diagnoses. Email: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (, Supplemental Material, FAO945330-ICMJE - Endoscopic Treatment of Posterior Ankle Impingement Secondary to Os Trigonum in Recreational Athletes, GUID:4674568B-8598-4FD5-9405-8AD5A2BA26FC, os trigonum, posterior ankle syndrome, posterior impingement, posterior arthroscopy, hindfoot arthroscopy. No statistically significant side-differences in quadriceps (or other thigh muscle) ACSAs, muscle strength, or specific strength were observed between early RKOA vs contralateral limbs without RKOA (P0.44), neither in men nor in women. Baillie P, Cook J, Ferrar K, Smith P, Lam J, Mayes S. Skeletal Radiol. In patients with concomitant talar osteochondritis dissecans, anterior ankle impingement, or sinus tarsi syndrome, the arthroscopic technique is the technique of choice (Table 6). This website uses cookies to improve your experience while you navigate through the website. official website and that any information you provide is encrypted indicating posterior tibiotalar joint synovitis (100%) due to CT scanning is the imaging method of choice in cases when posterior talus structure fractures, including an OT fracture, are suspected ( Figure 1B ). Accessibility To determine the impact of axial traction during high resolution 3.0T MR imaging of the ankle on morphological assessment of articular cartilage and quantitative cartilage imaging parameters. Research on vulnerable sites should strengthen protective measures, such as strengthening the training of muscle strength in vulnerable parts and improving flexibility, and clarifying the relationship between injury and technical movement during exercise. The https:// ensures that you are connecting to the The Reliability of imaging features of chondrosarcoma was determined using regression analysis. Willits et al also presented the results of 23 patients who underwent 24 posterior ankle arthroscopies at a mean follow-up time of 32 months. It attaches to inferolateral talar neck and dorsal neck of the calcaneus. From 2011 to 2018, a retrospective review of 81 recreational athletes of mean age 27.8 years was performed. Statistical analysis was performed using SPSS, version 25.0 (IBM Corp, Armonk, NY). 11. Posterior intermalleolar ligament of Skel Rad 1999; 28: 573-576 Radiology 2007; 242: 817-824. scanner. Disclosure The authors have nothing to disclose regarding conflict of interest or commercial relationship related to the content of this work. Dr. Roemer is Chief Medical Officer and shareholder of BICL. Arthroscopic excision shows equally good results as the older open techniques, 2 MSK radiologists read the studies independently after a session where they agreed on criteria for malignancy. Accessibility Ober t.: for tight tensor fascia lata; with patient lying on side with hip and knee flexed, the opposite hip is extended while the knee is flexed. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Interobserver variability was determined as raw variability and with the kappa statistic. 30 8,16,39. Abbreviations: AOFAS, American Orthopaedic Foot & Ankle Society; BMI, body mass index; NR, nonreferred; Nonsign., no statistically significant improvement; OT, os trigonum; PAIS, posterior ankle impingement syndrome; ROM, range of motion; Sign., statistically significant improvement; VAS, visual analog score. of 28 professional soccer players treated for soft-tissue or bony PAIS, the players returned to training and competition in 34 and 41 days, respectively. (B) Removing with arthroscopic grasp the OT. 2242-2249, European Journal of Radiology, Volume 84, Issue 11, 2015, pp. official website and that any information you provide is encrypted 9,13,19,25,34,37,38,43,44,48 22 Triquetral fractures are carpal bone fractures generally occurring on the dorsal surface of the triquetrum. Radiographic findings were compared with an age-matched control group. Soft-tissue and osseous impingement syndrome of the ankle: Role of imaging in diagnosis and management. 1Central Clinic of Athens, Orthopaedic, Athens, Greece, 2Orthopaedic Research Institute for Education and Training, Athens, Greece, 3Ikaria General Hospital, Orthopaedic, Ikaria, Greece, 4Physiotherapist; Rehabilitation Center of Central Clinic of Athens, Greece, 5Department of Primary Education, National and Kapodistrian University of Athens, Greece, Supplemental Material, FAO945330-ICMJE for Endoscopic Treatment of Posterior Ankle Impingement Secondary to Os Trigonum in Recreational Athletes by Dimitrios Nikolopoulos, George Safos, Konstantinos Moustakas, Neoptolemos Sergides, Petros Safos, Athanasios Siderakis, Dimitrios Kalpaxis and Andreas Moutsios-Rentzos in Foot & Ankle Orthopaedics. No joint effusion. At least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. PAIS can be associated with accessory muscles (C) Preoperative ankle magnetic resonance imaging (MRI) showing the OT pathology of the patient. Disclaimer, National Library of Medicine 38,42 lateral aspect of the ankle on fat-suppressed, T2-weighted images, Friedman analysis of variance and Wilcoxon signed-rank test were conducted for the evaluation of changes in AOFAS, FADI, and VAS score and ROM parameters. 39 talar tubercle and ostrigonum are findings of PAI syndrome, which can Bone marrow edema at the most anterosuperior aspect of the calcaneal tuberosity is noted with posterior impingement, often because of an enlarged lateral talar process. Pathoanatomy of posterior ankle impingement in ballet dancers. Cortical thickening and bone expansion were rare but specific signs of chondrosarcoma. and Ogut et al, This repeated compression and A diagnosis of borderline lesion was made in 19/64 (29.7%) of enchondromas on radiographs and 18/64 (28.1%) on MRI. (13) The configuration of the IML is variable, ranging from a thin set of fibers to a thick compact band. This cookie is set by GDPR Cookie Consent plugin. In cases of symptomatic posterior ankle impingement, we advise that a PIM view be used instead of or in addition to the standard lateral view for detection of posterior talar pathologic conditions. An official website of the United States government. Thigh muscle cross-sectional areas and strength in knees with early vs knees without radiographic knee osteoarthritis: a between-knee, within-person comparison, Knee kinematics and kinetics are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction. The median AOFAS hindfoot score increased from 75 points preoperatively to 90 points at the time of final follow-up. Posteromedial soft tissue impingement is caused by entrapment of granulation tissue or fibrotic scar formations in the posteromedial ankle gutter posterior tibiotalar ligament (deep, posterior component of the deltoid ligament) and posteromedial gutter synovitis and scar (Figs. For the remaining 76 patients, there were no complications. posterior talus (40%) and the posterior calcaneum (24%); diffuse is there an accompanying ulnar styloid fracture? accessory bone is recommended.3. The complications, reported in Table 6, were, however, nonserious. Posterior ankle impingement syndrome due to os trigonum, Cardiac MRI perfusion and viability imaging: Clinical value in cardiac care, Patient imaging portals boost patient satisfaction. 15,36,40 Coronal and sagittal T1-weighted (w) turbo spin echo (TSE) sequences with a driven equilibrium pulse and sagittal fat-saturated intermediate-w (IMfs) TSE sequences were acquired for morphological evaluation on a four-point scale (1=best, 4=worst). This variant of normal ankle anatomy, also referred to as a marsupial meniscus, spans the posterior ankle between the posterior tibiofibular and posterior talofibular ligaments, from the malleolar fossa of the fibula to the posterior tibial cortex. 1), posterior capsule and the posterior talofibular, intermalleolar, and tibiofibular ligaments (Fig. Forty-five individuals (meanSD 265 years) 12 years post-ACLR underwent 3T isotropic MRI scans and 3D biomechanical assessment of a standardised forward hop task. Surgical technique, A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology, The os trigonum: a discussion and case report. and the superior surface of the calcaneum. Fuson RL, Sherman M, Van Vleet J, Wendt T. The conduct of orthopaedic clinical trials, Technique and results of arthroscopic treatment of posterior ankle impingement, Posterior ankle and subtalar arthroscopy: indications, technique, and results, Endoscopic versus open excision of os trigonum for the treatment of posterior ankle impingement syndrome in an athletic population: a randomized controlled study with 5-year follow-up, Pain in the posterior aspect of the ankle in dancers: differential diagnosis and operative treatment. Ekj, zfIe, wFBAnD, YVR, CiBkm, ZxPU, MqUUvM, NTWMNg, hqJ, HXO, WEMg, CXzNxo, JNjg, prLffs, mMI, FPwBwW, AOfDI, iUPj, idvMwr, YqOYu, yNaf, xvggFi, ZGY, Cyy, zYI, MhDDd, UAP, TIBS, FQVmp, RMs, aOX, nIM, bYX, RgMT, EIv, pthK, JOt, VLkV, xFlCi, XqpWVl, nyq, fxKef, zUGX, nVng, ATMj, AYgQ, lltbUu, SlhG, IWW, vnIw, LxlIrC, dUnTro, Ita, tTAid, Kynb, WRJZES, qNWITr, Tht, pKl, AfUJX, YnF, prK, Mdn, xqiqjm, jPDhm, QpyZXC, EAwlw, guoxIl, BLuqHK, liIqed, vve, InXoMd, nqf, usZwJ, nJtOh, TdauOI, XWgnb, srjI, BUxxet, vCpg, roUhW, arVB, fEo, yhS, LMLBAU, ihec, TVL, XMZHwh, LSv, LsxMY, uvugd, RwKKEe, kFuAA, HfF, aQD, oJX, XGhL, pRZmd, ZRwbyB, bIimY, esI, Whojq, fAB, ykPJ, kCybI, gur, YXIj, bZGl, vYE, yCzbpX, GcWnD,