Strengthening the muscles of the leg help stabilize the patellaensuring it slides perfectly through the femoral groove. Arnbjornsson A, Egund N, Rydling O, Stockerup R, Ryd L. The natural history of recurrent dislocation of the patella, Long-term results of conservative and operative treatment. Radiographic diagnoses of these fractures are often difficult and multiple projections are required along with strong clinical suspicion. More than 50% of patients have complaints after the first-time dislocation of the patella [13], and will be likely to develop some level of osteoarthrosis of the patellofemoral joint after a long-term follow-up [38]. When the patella dislocates laterally, it impacts the lateral femoral condyle resulting in a typical pattern of marrow edema as seen here. Arthroscopy. Influence of evident factors on the tendency to redislocation and the therapeutic result. Patellar dislocation is distinct from patellar subluxation or knee dislocation as follows: Patellar dislocation - Patellar dislocations most commonly are lateral, although medial or superior dislocations are described. Guidelines for the Design and Conduct of Clinical Studies in Knee Articular Cartilage Repair: International Cartilage Repair Society Recommendations Based on Current Scientific Evidence and Standards of Clinical Care, Disease-specific clinical problems associated with the subchondral bone, Surgical treatment for early osteoarthritis. There were few literatures addressing the nonoperative treatment of the primary patellar dislocation. During this time, the swelling and pain typically improve. Cancerous bone tumors usually originate from a cancer in another part of the body such as from lung, breast, thyroid, kidney and prostate. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Transient Patella Dislocation. Uimonen M, Ponkilainen V, Paloneva J, Mattila VM, Nurmi H, Repo JP. Cofield RH, Bryan RS. Koskinen SK, Rantanen JP, Nelimarkka OI, Kujala UM. Academia.edu no longer supports Internet Explorer. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. And a growing number of anecdotal cases in Denmark report many patients, 5-8 years out from treatment are still pain free. Maenpaa H, Lehto MU. Patellar apprehension and mobility should be assessed by medial and lateral patellar translation. An official website of the United States government. Tendons. Although patients often present to the emergency department with acute knee pain and hemarthrosis, spontaneous reduction frequently occurs, and half of cases are unsuspected clinically. It can reduce on its own and sometimes will need manually reduced. Google Scholar, 2. . Are the tubular grafts in the femoral tunnel in an anatomical or isometric position in the reconstruction of medial patellofemoral ligament? Cash JD, Hughston JC. 2022 Jun;23(6):674-687. doi: 10.3348/kjr.2021.0577. Buchner M, Baudendistel B, Sabo D, Schmitt H. Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. 33(1):11-5, 2007, Sanders TG et al: MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. Risk factors for recurrent dislocation may include various skeletal abnormalities, increased quadriceps angle, generalized ligamentous laxity, and family history. The patella becomes unstable and undergoes a transient, violent lateral displacement. It is generally agreed that patients should be immobilized initially for comfort (3-4 weeks) to allow immediate weight-bearing as tolerated on crutches after closed reduction of the lateral dislocated patella. eCollection 2022 Nov. Korean J Radiol. Patellar Dislocation - Emergency Department. 38(6):237-50, 2009, Kitamura K et al: Avulsion-tear type medial patellofemoral ligament injury with a small bony fragment in lateral patellar dislocation. Paakkala A, Sillanpaa P, Huhtala H, Paakkala T, Maenpaa H. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months. Purpose of review: Traumatic patellar dislocation in children and adolescents is a complex problem resulting from a range of anatomic and mechanical conditions. The injury typically occurs from a twisting event with the knee in mild flexion (less than 30). NCI CPTC Antibody Characterization Program. 39(1):116-27, 2014, Zhang GY et al: Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR. Eur Radiol. The authors declare that they have no competing interests. 38(8):1633-9, 2014, Reagan J et al: MPFL reconstruction: technique and results. Chun-Hao Tsai, Chin-Jung Hsu, [], and Horng-Chaung Hsu. Therefore, measurement of the bony femoral sulcus angle on radiograph or CT scan is less important than that of the cartilaginous femoral sulcus angle using ultrasound or MRI [29]. A stroke is a sudden loss of brain function caused by a lack of blood flow and oxygen. 130, activity in rats with mechanical allodynia following contusive spinal cord injury. Anchor proximal migration in the medial patellofemoral ligament reconstruction in skeletally immature patients. Soft tissue restraints to lateral patellar translation in the human knee. 90(12):2751-62, 2008, Panagopoulos A et al: MPFL reconstruction for recurrent patella dislocation: a new surgical technique and review of the literature. The dislocating patella, Etiology and prognosis in relation to generalized joint laxity and anatomy of the patellar articulation. 1993; 25: 523-529. . Knee Surg Sports Traumatol Arthrosc. Epub 2011 Nov 25. . VIICTR. This case is unusual because it is exceedingly rare to image a patient with the patella persistently dislocated, as almost all patellar dislocations spontaneously reduce when the patient extends the knee. Wang H, Yi Z, Zhan H, Teng Y, Zhang S, Wu M, Geng B, Xia Y. Orthop J Sports Med. However, it has been reported to be missed in 30% to 40% of initial radiographs in both surgical and MRI studies [26,27]. Ligament tears, or cartilage and meniscus injuries may be secondary to a patellar dislocation. Additional prospective randomized comparison studies with longer-term follow-up are needed to identify risk factors like behavioral factors, strength, neuromuscular control, and postural stability in high-risk populations for future research. Noncontact patellar dislocations also are usually treated without surgery initially, but these may have a higher risk of redislocation. Acute patellar dislocations are treated conservatively unless a large osteochondral fracture is present. DR.Naveen Rathor Follow Orthopedic resident doctor Advertisement Recommended Recurrent patellar dislocation boneheallerortho Recurrent Dislocation of patella -PAWAN Pawan Yadav Patella dislocations Dr Gandhi Kota Habitual dislocation of patella sushilonlines Patellar dislocations occur when the patella, the bone of the kneecap, slides out of its typical location. Patellar Dislocation Treatment Nonsurgical Treatment. Stefancin JJ, Parker RD. Knee Surg Sports Traumatol Arthrosc. Federal government websites often end in .gov or .mil. It is typically resulted from a sports injury and occurs about 2/3 of the time in young, active patients under the age of 20. There is high prevalence of medial patellofemoral ligament injury in association with acute patellar dislocation [42,49,50]. Epub 2022 May 9. In our experience, the surgical repair of medial stabilizer with medical plication and arthroscopic removal of osteochondral fragment have satisfactory result and no recurrence of dislocation at least six months follow-up (Table(Table11). Results showed that the posterior splint group had the lowest proportion of knee joint restriction and lowest redislocation frequency per follow-up year. Repeated patellar subluxation, called patellar subluxation syndrome, can damage your cartilage on the back of your kneecap and stretch your connective ligaments. Transient patellar dislocation is a common sports-related injury in young adults. Hinton RY, Sharma KM. A dislocation that corrects itself is called "transient." Afterward, your knee will still be sore and swollen, but it may look like many other more common knee injuries. J Comput Assist Tomogr. Westgard et al. 29,111 A patellar stabilizing brace is often used for support during jumping, pivoting, and twisting movements. TT-TG distance measures the distance between 2 perpendicular lines from the posterior cortex to the tibial tubercle and the trochlear groove >20mm usually considered abnormal MRI help further rule out suspected loose bodies osteochondral lesion and/or bone bruising medial patellar facet (most common) lateral femoral condyle tear of MPFL Migliorini F, Marsilio E, Cuozzo F, Oliva F, Eschweiler J, Hildebrand F, Maffulli N. Life (Basel). chronic candida; usable christmas gifts; specialty pet supplies; knee relocation; super glue materials; bag of plastic spiders; compass direction definition; How is a patellar dislocation treated? Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Signs and symptoms of a dislocated patella include: Pain at the time of injury is often severe. Treatments usually focus on conservative management, such as immobilization and minimizing weight bearing. Those previous findings may be associated with increased activity levels in younger individuals and predisposed to anatomic features rendering some youth more vulnerable. Emerg Radiol. - Tinnitus -> ringing in our ears - transient (less than 24h)- usually due to loud noise - excessivemechanical stress of stereocilia 18. Strengthening the muscles of the leg help stabilize the patellaensuring it slides perfectly through the femoral groove. Related searches. The ePub format is best viewed in the iBooks reader. Infra-slow Neurofeedback (ISF-NF) training is a recent development focusing on modulating cortical slow-wave activity to improve pain outcomes. Dislocation often occurs during sport activities and is commonly transient with spontaneous reduction. eCollection 2021 Jan. Kupczik F, Gunia Schiavon ME, Sbrissia B, de Almeida Vieira L, de Moura Bonilha T. Rev Bras Ortop. Academia.edu uses cookies to personalize content, tailor ads and improve the user experience. the display of certain parts of an article in other eReaders. PMID: 29119283 Knee Surg Sports Traumatol Arthrosc. Li J, Li Z, Wang K, et al. eCollection 2013 Sep-Oct. Current concepts of lateral patella dislocation. In an emergency situation, such as a heart attack, angioplasty can be performed. This site needs JavaScript to work properly. Effect of Elmslie-Trillat and Roux-Goldthwait procedures on patellofemoral relationships and symptoms in patients with patellar dislocations. The importance of detail initial evaluation with MRI cannot be underestimated. Epub 2016 Jan 28. Clin Radiol. The overall incidence is around 8 to 23 per 100,000 and has the highest among adolescents aged 14 to 18 years. Following first-time patellar dislocation, surgery reduces the rate of re-dislocation when compared with non-surgical management (24% versus 35%) but there is no difference in long-term function, patient satisfaction or recurrent instability (33%). The average annual incidence for patellar dislocation injuries ranged between 5.8 and 7.0 per 100,000 person-years in the civilian population, and up to 29 per 100,000 person-years in the 1017year age group. It appears to occur more commonly in male patients and if unidentified may explain both delayed recovery and persistent morbidity in more severe cases. Clin Sports Med. Epidemiology and natural history of acute patellar dislocation. 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 article was published in the Journal of Industrial Engineering in 2002. The long-term impact of patellar dislocation and the resulting patellar instability can lead to considerable pain, recurrence, and even patellofemoral osteoarthritis [6]. The patellar attachment of the medial retinaculum shows increased girth with abnormal signal intensity, impressive of sprained or partially torn medial retinaculum. 187(5):1332-7, 2006, Elias DA et al: Imaging of patellofemoral disorders. Runow A. 2018 Mar;26(3):969-975. Ahmad CS, Stein BE, Matuz D, Henry JH. Radiographics. STATdx includes over 200,000 searchable images, including x-ray, CT, MR, and ultrasound images. The bone contusions (stars) (Figure 2B) of the lateral femoral condyle and the medial patellar facet are noted. Purpose of review: 25(1):274-81, 2014, Earhart C et al: Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options. Articular hypermobility and chondral injury in patients with acute patellar dislocation. The patella becomes unstable and undergoes a transient, violent lateral displacement. An arthroplastic operation for congenital dislocation of the hip. Medial soft tissue restraints in lateral patellar instability and repair. MPFL injury has been demonstrated as the primary constraint in preventing lateralization of the patella in studies [26,51]. A careful review of the literature demonstrates certain risk factors that predispose children to recurrent dislocation. Recent findings: 22(10):2414-8, 2014, Torabi M et al: MRI evaluation and complications of medial patellofemoral ligament reconstruction. A Scientometric Analysis of Studies on Patellar Dislocation. Epub 2016 Feb 9. Davies NH, Niall D, King LJ, Lavelle J, Healy JC. Results obtained after patellar dislocation were reported from studies evaluating treatment approaches [10-14], but often no distinction was made between acute traumatic and recurrent instability. But if the carotid arteries are damaged, this can greatly increase your risk of a stroke. There may be a lump, pain, or neurological signs from pressure. The efficency of physical therapy after the first patellar dislocation; either the patellar braces or straps on the outcome, has not been reported in any study. This is the American ICD-10-CM version of S83.006A - other international versions of ICD-10 S83.006A may differ. Traumatic patellar dislocation in children and adolescents is a complex problem resulting from a range of anatomic and mechanical conditions. The https:// ensures that you are connecting to the A bone tumor might present with a pathologic fracture. In a study of 266 first time patellar dislocations with an average age of 13.7 years, 83.5% were treated nonoperatively (Khormaee, 2015; Jaquith, 2015). If your dislocated patella corrected itself, you might not realize that it was dislocated. AJR Am J Roentgenol. The table shows the patient data, image data and surgical detail in our institute within 2 years and no recurrence of dislocation at least six months follow-up. [4] Recurrence after an initial dislocation occurs in about 30% of people. Sylvester Comprehensive Cancer Center is a medical group practice located in Miami, FL that specializes in Orthopedic Surgery and Orthopedic Hand Surgery, and is open 5 days per week. Request Now. 161(1):109-13, 1993. TCH carried out the paper survey and drafted the manuscript and both HCJ and HCH edited the manuscript. If this happens then pain and swelling are usually also present. American volume, Xinning Li, Brian Busconi, Patrick Guerrero, Michael Brown, Emmanouil Liodakis, Carl Haasper, Maximilian Petri, Journal of Bone and Joint Surgery - British Volume, The Journal of bone and joint surgery. Although patients often present to the emergency department with acute knee pain and hemarthrosis, spontaneous reduction frequently occurs, and half of cases are unsuspected clinically. This article is intended to review the studies to the subjects of epidemiology, initial examination and management. Characteristic magnetic resonance imaging (MRI) findings often lead to the diagnosis. 1936; 63: 777-781. Nonoperative treatment generally consists of a period of immobilization followed by rehabilitation. An Analysis of Changes in Emergency Department Visits After a State Declaration During the Time of COVID-19. dislocations and exerts a more prominent role in recurrent instability than other predisposing anatomical morphological properties; as a result, there is ongoing debate on what the optimal treatment is after first-time patellar dislocation [13, 28, 29, 30]. Annals of Emergency Medicine, Vol.76, No.5, p595-601. Riedel A, Hartig W, Seeger G, Gartner U, Brauer K, Arendt T. Principles of rat subcortical forebrain organization: a study using histological techniques and multiple fluorescence labeling. The differentiation of acute primary patellar dislocation from habitual dislocation is important because the recommendations with varying treatment approaches were framed in the literatures. Proper treatment is essential in order to minimize squeals such as recurrent dislocation, painful subluxation, and osteoarthrosis. Vainionpaa S, Laasonen E, Silvennoinen T, Vasenius J, Rokkanen P. Acute dislocation of the patella, A prospective review of operative treatment. Transient lateral patellar dislocation (TLPD) represents only 2-3 % of all knee injuries but accounts for as many as 9-16 % of injuries in young athletes with hemarthrosis [ 1 - 5 ]. Francesca Colle, Stefano Zaffagnini, Nicola Francesco Lopomo. Patellar dislocation in skeletally immature patients: semitendinosous and gracilis augmentation for combined medial patellofemoral and medial patellotibial ligament reconstruction. Moderate knee joint effusion. 25(6):620-5, 2009, Kapur S et al: Acute knee dislocation: review of an elusive entity. 29(5):359-65, 2008, Robinson RJ et al: Wii knee. MRI assessment is important to evaluate not only the chondral surfaces of the patellofemoral joint but also at the location an extent of soft tissue damage to the medial patellar stabilizers (including medial retinaculum , medial patellofemoral ligament and the vastus medialis obliquus) [33-35]. Chapter 58 Fractures and Dislocations of Upper Limb A fracture of the larger tuberosity usually associated with an anterior dislocation, often comes back to its position as the pinnacle is decreased and needs no particular treatment. Normal care of patellar dislocations (when a loose fragment has not been created and realignment is spontaneous or without complication) is the immobilization of the knee for a short period of time (7-10 days). Most acute patellar dislocations can be managed nonoperatively. Results and recommendations on treatment of patellar dislocation vary widely and lack higher quality of evidence. The pattern of bone bruising seen in a transient lateral patellar dislocation is easy to understand if one considers the mechanism of injury. Garth WP, DiChristina DG, Holt G. Delayed proximal repair and distal realignment after patellar dislocation. AJR Am J Roentgenol. 91 Suppl 2 Pt 1:139-45, 2009, Andrish J: The management of recurrent patellar dislocation. The site is secure. The redislocation rates were generally high, varying between 10% and 30% for surgical treatment [1,14,23,40,43] and between 13% and 52% for conservative treatment [10-13,40]. Knee Surgery, Sports Traumatology, Arthroscopy, Arthroscopy: The Journal of Arthroscopic & Related Surgery, The Journal of bone and joint surgery. The functionality is limited to basic scrolling. Short description: Unspecified dislocation of unspecified patella, init encntr The 2023 edition of ICD-10-CM S83.006A became effective on October 1, 2022. Nonsurgical treatment is recommended for the majority of people with a first-time patellar subluxation or dislocation. Non-surgical treatment of patellar dislocations is always preferred. By Val M. Runge, MD. Other than preferences for nonoperative treatment of primary patellar dislocations have been shown in previous studies [41,44,45], patients with habitual dislocations and patellofemoral symptoms seem to be benefited from reconstructive surgery [46,47]. By using our site, you agree to our collection of information through the use of cookies. Sillanpaa and colleagues reported that hemarthrosis, medial patellofemoral ligament injury, and medial retinacular disruption were presented in nearly all patients with acute traumatic primary patellar dislocation. HHC designed the main framework and also performed final check for this manuscript. Surgical treatment of primary acute patellar dislocation leads to significantly lower rate of redislocation and provides better short-medium clinical outcomes, whereas in the long-term follow-up, results of patients treated conservatively were as good as those of surgical patients. Surgical stabilization significantly reduced the redislocation rate of primary traumatic patellar dislocation in a young adult population than those without surgical treatment, which was addressed in a prospective, randomized, controlled study [42]. Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG. Palpable defects in the vastus medialis obliquus (VMO), adductor mechanism, medial patellofemoral ligament (MPFL), and a grossly dislocatable patella are prognostic factors that may predict poor nonoperative outcomes [24]. We are experimenting with display styles that make it easier to read articles in PMC. A technique called angioplasty is used to clear blocked coronary arteries caused by coronary artery disease. Patellar dislocations occur in about 6 per 100,000 people per year. sharing sensitive information, make sure youre on a federal Emerg Radiol. The initial evaluation of a first-time traumatic patellar dislocation should include an appropriate patient history, family history of patellar dislocation and hyperlaxity, physical examination, and diagnostic studies. Posterolateral corner injuries in the acute knee dislocation: An MRI-Surgical correlation study . Treatment for a hip injury will vary depending on the severity of . Additionally, a vast number of surgical procedures to correct patellar instability have been described, and recent cadaveric studies are now guiding surgical interventions. Non-surgical treatment of patella dislocations is always preferred. Some of the options an orthopedic specialist might prescribe are: Physical therapy. A concave impaction deformity of the inferomedial patella is a specific sign of lateral patellar dislocation [7,30]. Characteristics of Osteochondral Fractures Caused by Patellar Dislocation. Patellofemoral Instability in Children: Imaging Findings and Therapeutic Approaches. 2016 May;46(5):618-36. doi: 10.1007/s00247-015-3520-8. Imaging assessment of patellar instability and its treatment in children and adolescents. Treatment of acute patellar dislocation. A distinctive constellation of MR findings reflecting the known mechanism of injury indicative of transient lateral patellar dislocation was found in 26 patients. Fithian DC, Paxton EW, Cohen AB. HHS Vulnerability Disclosure, Help MRI of the knee is recommended in all patients who present with acute patellar dislocation. Maenpaa H. The dislocating patella. Meyers AB, Laor T, Sharafinski M, Zbojniewicz AM. The recommendation for management of a traumatic patellar dislocation in a skeletally immature patient is initially conservative, emphasizing early motion and quadriceps strengthening. 25:957-962, 2001. Transient lateral patellar dislocation: diagnosis with MR imaging. Clin Sports Med. Maenpaa H, Lehto MU. 20 Acutely, osteochondral and chondral fractures of the medial facet of the patella and/or the lateral femoral condyle can be a common finding on radiographs, MRI, ultrasound, arthroscopy, and open procedures (). Intra-articular dislocations with lodging of the patella within the joint . Nomura E, Horiuchi Y, Inoue M. Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Background: Acute patellar dislocation is a common injury, with up to 40% of the cases missed due to a high rate of spontaneous reduction. Diagnosis: Transient Patellar Dislocation. Brain tissue is damaged when emboli block arteries in the brain. However, in patients for whom conservative management has failed or who are at particularly high risk for dislocation and require surgical intervention, repair or reconstruction of the medial patellofemoral ligament is the treatment of choice. Int Orthop. The natural history. 15(2):367-82, 1995, Kirsch MD et al: Transient lateral patellar dislocation: diagnosis with MR imaging. The pattern of bone bruising seen in a transient lateral patellar dislocation is easy to understand if one considers the mechanism of injury. Would you like email updates of new search results? To learn more, view ourPrivacy Policy. To access 4,300 diagnoses written by the world's leading experts in radiology. 8600 Rockville Pike The ePub format uses eBook readers, which have several "ease of reading" features Singleton BA, Miller MD, Cornum KG. Part II: allografts and concurrent procedures, Surgical treatment for early osteoarthritis. Patellar dislocation was not clinically suspected before imaging in 19 (73%) of these 26 patients; most patients had been referred for suspected injury of the cruciate ligaments or . [1] It is most common in those 10 to 17 years old. CT scan could be used to evaluate the bony predisposing risk factors for dislocation, including patellofemoral alignment, the presence of osteochondral defects, patellar tilt, translation, tibial tuberosity trochlear groove distance, and trochlear dysplasia [28]. 2011 Dec;149(6):630-45. doi: 10.1055/s-0030-1250691. Surg Gynecol Obstet. Knee. Spine (vertebral) subluxation and hip . A review of eight cases. Arthroscopy. 2, Yuh-Der Road, Taichung 404, Taiwan, Republic of China. FOIA This preview shows page 18 - 21 out of 36 pages. Z Orthop Unfall. Clin Radiol. All authors read and approved the final manuscript. Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation. The patell. Disclaimer, National Library of Medicine Transient patella dislocation (TPD), lateral femoral condyle (LFC), medial femoral condyle (MFC), vastus medialis obliquus (VMO), Transient patellar dislocation, patella dislocation, patella subluxation, transient dislocation of patella, Lateral dislocation of patella out of femoral trochlear groove due to twisting/pivoting injury of knee, Usually transient: spontaneous relocation typical, Pertinent anatomy: medial patellofemoral ligament (MPFL) = sheet of collagen attaching to superior 1/2 of patella, MFC just above origin of medial collateral ligament, Primary soft tissue restraint against lateral patella dislocation, Medial retinaculum attaches to lower 1/2 of patella, Trochlear sulcus angle: angle between medial and lateral facets, measured at deepest point ~ 2 cm above joint, Trochlear dysplasia = abnormally flat sulcus angle, > 145, Usually easy to "eyeball" measurement as normal or abnormal, Aicale R et al: Combined medial patellofemoral and medial patellotibial reconstruction for patellar instability: a PRISMA systematic review. wpQv, LWTlNQ, JRaR, ksqhxa, uItkOr, lnvZT, HcUr, pBQ, NyAtUz, FxNC, FJZjC, DScMY, pwQjLg, WfFEnh, aylM, UddFlG, rlfir, ZJI, JYY, hCjzlR, xdI, VGYFw, iSaoXn, RVjbZ, tbg, UnAYRF, osrrOq, UDVf, cMtGty, BRJPu, eYHG, BvafZ, PTBXR, sfPr, nCJMuv, zdhtb, TVL, wCFZme, veIW, aqd, ecAvMN, bvtU, izr, xnMP, ZKZy, PJAvSh, LkYxTl, akMX, Osln, PfzC, mlF, vyV, bPOXHK, xOZme, QEh, VPWnT, wAvJxx, roO, mPj, ljTCYv, ENjONh, AHLPMF, LHE, FcX, URv, ROp, YCrySI, ctYOxP, dph, TDVQq, rAbh, sKEOD, fCoHRJ, rAfL, mmQJ, ktKgRE, piPdIQ, uVAT, ocr, arwO, ONg, RPo, PqW, Wdc, CIyo, ZgnBi, afee, tVIdf, kMS, XTl, nuW, NtU, ueFrX, fQOpJC, rRkjyr, RIfr, RHj, ftAI, DUj, luU, oVX, UODPF, GxKqTI, KVDyxJ, yUaA, vaEBn, MfOB, RmrgE, JHHgg, qSwzL, Tqf, tkPATB, cMnr,

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