43 year old man c/o recurring pain at the back of this left ankle. Would you like email updates of new search results? Tend to be more common in female. cortex, trabeculae, and marrow) and can occur within the body of the tendon or at its calcaneal insertion. PMID: 29327128 DOI: 10.1007/s00256-017-2852-x Adult Conservative Treatment Female Fractures, Avulsion / diagnostic imaging* Fractures, Avulsion / therapy Humans Metatarsal Bones / injuries* Archilles tendon soft tissue shadow is also thickened. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-40410. 1) avulsion fracture of the greater tuberosity is seen at the supraspinatus tendon attachment. Achilles tendon Peroneal tendons Accessory muscles MRI protocol Systematic approach We use a checklist when evaluating an MRI of the Ankle: Bones: screen on fatsat images for bone marrow edema. Achilles tendon ossification is more common in males 4. Alfredson H, Cook J. Check for errors and try again. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. Achilles tendon ossification. Bosman WM, Leijnen M, van den Bremer J, Ritchie ED. PMC Avulsion of the bony insertion of the Achilles tendon at the calcaneus is infrequent and is diagnosed by radiography. Unable to load your collection due to an error, Unable to load your delegates due to an error. Ruptures near its insertion into the calcaneus are less common and mostly found in hyperpronators with a heel spur (Haglund's deformity). ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Br J Sports Med. This type of extra-articular fracture is typically the result of twisting forces in . The Achilles tendon is the largest and the most frequently ruptured tendon in the lower extremity. This occurs as tendons can bear more load than the bone. AJR Am J Roentgenol. Avulsion injuries or fractures occur where the joint capsule, ligament, tendon or muscle attachment site is pulled off from the bone, usually taking a fragment of cortical bone. Tears can be acute or chronic, with repeated minor trauma. It can affect a range of people from athletes to recreational exercisers and even inactive people. Screw fixation is not effective to resist the pull out tension of the triceps surae. The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. More secure fixation method is necessary in order to allow early functional rehabilitation. Achilles tendon ruptures occur commonly in the midsubstance of the tendon, usually 2-6 cm proximal to the insertion to the calcaneus. J Orthop Surg Res. The Injury I had what is called an Avulsion Fracture of the Achilles tendon. A fracture is a break or crack in a bone that often results from an injury. Types 3 and 4 fractures occur in younger people and require more-severe . The mean FFI, AAS, and Tegner scores after the operation were 11.84 1.62, 5.71 . A cutoff value of 1 cm in anteroposterior diameter is usually used for diagnosis ref. Radiograph of the right foot showing a type II avulsion fracture of the posterior superior calcaneus in a 75-year-old woman. Location 2. [Tendon-splitting approach for the surgical treatment of Haglund's deformity and associated condition. 64 year old female, had a motorbike accident a month ago. Clipboard, Search History, and several other advanced features are temporarily unavailable. Several ankle ligaments ensure the static and dynamic stability of the ankle joint, but they are prone to injury due to acute trauma as well as repetitive ankle sprains. Rompe JD, Furia JP, Maffulli N. Mid-portion Achilles tendinopathy-current options for treatment. Achilles rupture can occur with or without these underlying tendon pathologies. There is also evidence of neovascularization, which, if present, is usually indicative of a poorer outcome and more severe clinical symptoms ref. There may be a familial or genetic component 3. A novel technique using Achilles SpeedBridge and a cannulated lag screw is performed and it is believed that this technique is highly effective for the treatment of type I calcaneal avulsion fractures. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-5589. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. This is called calcific tendinitis a self-limiting condition. It mainly occurs in people playing recreational sports, but it can happen to anyone. Check for errors and try again. 2000;175 (3): 613-25. . J Res Med Sci. Here, the study suggests Achilles tenodesis technique using suture anchor after resection of the CIA fracture fragments could provide satisfactory clinical results in the cases of surgically indicated CIA fractures. Unable to process the form. Calcaneal Avulsion Fracture With Achilles SpeedBridge Repair - YouTube 0:00 / 5:25 Sign in to confirm your age This video may be inappropriate for some users. Usually, there is no evidence of inflammation, but the cause is thought of as a failed healing response 1. Moreover, the prominent screw head may cause skin impingement. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Karjalainen PT, Soila K, Aronen HJ et-al. It is hard to differentiate clinically from paratendinopathy (which is most common). The VAS pain score and AOFAS Ankle-Hindfoot score improved from 4.87 1.61 preoperatively to 2.07 1.57 postoperatively and from 58.32 18.66 preoperatively to 87.32 7.53 postoperatively, respectively (both P < .001). Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-35974. Umans H, Pavlov H. Stress fractures of the lower . Radiology 1995; 194:825-829 [Google Scholar] 65. Diagnosis of calcific tendonitis was made. the fracture fragment measures 16 x 18 x 12 mm. Joints: screen for effusion and look at the joint capsule for thickening. Related to tendon ossification, inflammation may set in and cause symptoms. These conditions are common, often come to clinical attention, and are frequently imaged. The Archilles tendon is swollen and the Kager triangle is partially obliterated. There is a calcified focus posteriorly. J Clin Ultrasound. 45 year old man has been complaining of pain at the back of his left ankle on and off for years. It can sub-divided into insertional and non-insertional Archilles tendinitis depending on its location. There may be a familial or genetic component 3 . The Achilles tendon is the tendinous insertion of two muscles. X-ray showed an ossified Archilles tendon. 2011;16 (2): 233. 89 (1): 51-7. A treatment algorithm for managing Achilles tendinopathy: new treatment options. ADVERTISEMENT: Supporters see fewer/no ads. The site is secure. 2017 Jun;31:35-39. doi: 10.1016/j.foot.2017.04.002. Disclaimer, National Library of Medicine AJR Am J Roentgenol. Achilles tendinopathy refers to a combination of pathological changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. Achilles tendinopathy. 37 year old man c/o pain posterior left ankle 2/52. High risk of tendon rupture. Calcaneal Avulsion Fracture With. MR imaging of overuse injuries of the Achilles tendon. BMJ Case Rep. 2016 Jan 11;2016:bcr2015211581. FOIA Avulsion fractures are commonly distracted due to the high tensile forces involved. 8600 Rockville Pike Subscribe to our official NR Medical Academy Telegram Channel herehttps://t.me/nrmedicalacademyand click JOIN. 2007;41 (4): 211-6. An Achilles sleeve avulsion was recognized preoperatively in 7 of 11 (64%) cases, where lateral ankle radiographs demonstrated a small radiodensity several centimeters proximal to the calcaneal insertion. X-ray showed mild soft tissue swelling around the ankle with obliteration of Kagers triangle. Open reduction and internal fixation is indicated to achieve bone to bone healing and restoration of the function and continuity of the triceps surae mechanism. Achilles tendon ossification: pathology, imaging and aetiology. Achilles tendon ossification is more common in males 4 . Acta Chir Orthop Traumatol Cech. There are numerous sites at which these occur. The difference is that while a rupture is a violent partial or complete severing of the Achilles tendon an Avulsion Fracture happens when the tendon dismounts from the bone, often taking pieces of the bone with it. Avulsion fractures of the posterior calcaneal tuberosity are rare injuries; with a prevalence of 1-3% of all calcaneal fractures. Reattachment using the suture bridge augmentation for Achilles tendon avulsion fracture with osteoporotic bony fragment. Leung JL, Griffith JF. Ultrasound is the first-line imaging modality 6. Avulsion of the bony insertion of the Achilles tendon at the calcaneus is infrequent and is diagnosed by radiography. Careers. It is hard to differentiate clinically from paratendinopathy (which is most common). 3. Heard a sound followed by acute pain at his left ankle. This is strongly suggestive of archilles tendon rupture. Torn tendon may ossify. MRI studies may be indicated for surgical management of chronic injuries. Achilles tendinopathy refers to a combination of pathological changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. altered structure (e.g. This is consistent with ossification of Archilles tendon insertion and pathognomonic of Archilles tendinitis. 2021;:bjsports-2020-103867. The tendon is covered by fascia and skin. Accessibility Avulsion fractures of the calcaneal tuberosity are rare, accounting for only 3% of all calcaneal fractures. Case Rep Orthop. This is consistent with Calcific Archilles Tendinitis. You can use Radiopaedia cases in a variety of ways to help you learn and teach. They also occur in osteoporosis and hyperparathyroidism. 69F, c/o pain at back fo ankle for years. 1 PDF View 2 excerpts, cites methods and background Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions 2008;30 (20-22): 1651-65. It can be caused by traumatic traction (repetitive long-term or a single high impact traumatic traction) of the ligament or tendon. Bookshelf Dr. Kenny Chuu agrees. 2013;2013: 539740. The Achilles tendon is among the most frequently injured tendons of the body with a variety of types of traumatic and overuse conditions affecting it. Prabhakar G, Kusnezov N, Rensing N, Abdelgawad A. 3 Department of Radiology and Imaging Sciences, University of Utah, 30 N. 1900 E. No. Epub 2017 Mar 5. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Often shows thickening and rounding of the affected portion of the tendon. The Achilles tendon connects the gastrocnemius and soleus muscles to the calcaneal tuberosity. Avulsion fracture at the insertion of the Achilles tendon, with marked separation of fragments. eCollection 2022 Dec. Clin Interv Aging. 6. 1. No h/o trauma.Ankle x-ray showing multiple calcified foci within the Archilles tendon. Disabil Rehabil. This video demonstrates a speedbridge repair of a calcaneal avulsion fracture. This can neutralize the pull of the triceps surae and early post-operative rehabilitation programme is allowed. eCollection 2021. Check for errors and try again. CONCLUSION. Dr udayan das is an orthopedic surgeon. It is characterized by mature bone in all of its components (i.e. Achilles Tendon - Collection of Plain X-rays Achilles Tendon The Achilles tendon connects the gastrocnemius and soleus muscles to the calcaneal tuberosity. and transmitted securely. Unable to process the form. Kagers triangle is also partially obliterated, indicating inflammation and oedema. An avulsion fracture of the calcaneal tuberosity: delay of treatment causes the 'Achilles heel' of optimal recovery. Materials and methods: This retrospective study included seven patients of calcaneal avulsion fracture who had underlying diabetes . A common sports-related injury when lots of turning are involved such as squash and basketball. It begins at the midcalf level and it receives muscular fibers from three muscles: the medial and lateral heads of the gastrocnemius and the soleus muscles. 1. More common in males. It affects non-athletes in around one-third of cases. Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of your lower leg. there is adjacent marrow edema. It can be seen both in athletes and non-athletes. On lateral view of the ankle, this is called Kager triangle. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Calcaneal tuberosity avulsion fracture. Before The ossification can be seen either at the calcaneal insertion or within the body of the tendon. This is consistent with Archilles tendinitis. Please enable it to take advantage of the complete set of features! 52 year old man, was jumping to make a smash during badminton game. Macroscopically, tendinopathy results in enlargement,disruption of fibrillar pattern and an increase in tendon vascularity. 2000;175 (3): 613-25. doi: 10.1136/bcr-2015-211581. Diagnosis can be made clinically with weakness of plantarflexion with a positive Thompson's test. Can show increased intratendinous signal and tendon enlargement, with edema in Kager fat pad in cases of tendinosis. Br J Sports Med. Foot Ankle Clin. At the mildest end of the spectrum all that may be present is peritendonitis. Understanding of ankle injuries has evolved for the past few decades, influenced by capability to visualize ligaments, tendons, and bone marrow on magnetic resonance imaging (MRI). The joint Orthoplastic management of an Achilles tendon avulsion: A rare case report. The rest of the bone and joint morphology are normal. Case Discussion Avulsion fractures of the calcaneal tuberosity are rare, accounting for only 3% of all calcaneal fractures. There is a paucity of literature on this problem. Obliteration or distortion of Kager triangle indicates pathology at posterior ankle. Spondylosis Spondylolysis Spondylolisthesis. The bone fragment is excised and the tendon is repair back to the calcaneus (h. Evaluation and results]. Call us @ 7026-200-200 Medfin.in for more help Treatment is typically with open reduction and internal fixation, although minimally displaced fractures may be treated in a closed fashion. HHS Vulnerability Disclosure, Help J Foot Ankle Surg. The Achilles Tendon Total Rupture Score (ATRS) Criteria to Discharge Walking Boot . Since then, has been having pain at the back of this right ankle. 6. de Vos R, van der Vlist A, Zwerver J et al. Ligamentous ankle pathology mainly involve the lateral ligaments and to a lesser extent the. X-ray Lateral Avulsion fracture at the insertion of the Achilles tendon, with marked separation of fragments. A 27-year-old male asked: My mri-rightshoulder joint says below comments. MeSH Dutch Multidisciplinary Guideline on Achilles Tendinopathy. The rest of the ankle is normal. Foot (Edinb). X-ray showed enthesophyte at the insertion of Archilles tendon and calcified foci within its body. Unable to process the form. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 1 Avulsions from the calcaneal insertion or tears occurring in close proximity to the distal end of the tendon insertion represent a challenge in surgical repair due to insufficiency of the distal end, although these tears . Epub 2017 Apr 15. He works on an oil platform and find it difficult to perform his duties at times. Open repair of acute Achilles tendon ruptures. Sonography of chronic Achilles tendinopathy: a case-control study. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Weerakkody Y, Luong D, Foster T, et al. 4. Avulsion fractures involve the attachment site of a soft-tissue structure (eg, a ligament or tendon) and occur when the structure is pulled off the bone. 5. Pathology The spectrum of tears ranges from microtears to interstitial tears (parallel to the long axis of the Achilles), to partial tears, and eventually to complete tears (ruptures). 2012 Sep-Oct;51(5):666-8. doi: 10.1053/j.jfas.2012.05.004. X-ray showed dystrophic calcification at the insertion of left Archilles tendon. A diagnosis of calcific tendinitis was made. c/o pain at the back of right ankle and walks with a limp. Disabil Rehabil. Kager triangle is not obliterated. (2015) Acta radiologica open. Book appointments Online, View Fees, User Feedbacks. Related to previous trauma both macro such as previous surgery or micro such as badminton players. An ossified Achilles tendon may fracture. Epub 2012 Jul 4. This site needs JavaScript to work properly. Foot Ankle Clin. JPRAS Open. The https:// ensures that you are connecting to the government site. 2008;36 (1): 27-32. sharing sensitive information, make sure youre on a federal 2. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. The non-insertional variety is higher up in the tendon such as in this case. 2000;175 (1): 251-60. This condition is usually due to repetitive stress to the tendon. Purpose: To present a retrospective case series assessing the clinical outcomes of avulsion fracture of the Achilles tendon after a reattachment procedure and to identify potential factors predicting postoperative outcomes. Federal government websites often end in .gov or .mil. 2007 Dec;12(4):583-96, vi. Less than 3% 1 of calcaneal fractures involve the tuberosity. AJR Am J Roentgenol. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. The second is the soleus, which originates from the posterior surface of the tibia and the fibula as well as the interosseous. Intraoperatively, 90.9% of sleeve avulsions had a concomitant Haglund deformity and macroscopic evidence of insertional tendinopathy. The most frequent site of rupture is approximately 2 to 6 cm proximal to the insertion of the tendon on the calcaneus, whereas more distal ruptures occurring at the calcaneal insertionalso known as Achilles sleeve avulsionare less common [].In most cases, Achilles sleeve avulsion occurs . Achilles tendon rupture, previous surgery) as well as repetitive microtrauma 1. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. Achilles tendon rupture, previous surgery) as well as repetitive microtrauma 1. No h/o trauma fall. There is a strong association with diabetes, where they may occur spontaneously, and are thought to be due to peripheral neuropathy. This is the reason for the calcification. Pathology The etiology is unknown but Achilles tendon ossification is seen both with previous macrotrauma of the tendon (e.g. Achilles tendon ruptures usually occur 2-6 cm proximal to the insertion on the calcaneus bone, while avulsions from the calcaneal insertion are less commonly encountered. Arnaout F, Butt S. Fracture of ossified Achilles tendon. It may or may not be associated with an Achilles tendon tear. official website and that any information you provide is encrypted Additional signs include increased Kager fat pad echogenicity and thickening of a hypoechoic paratenon. Histopathologically, there is evidence of disorganized proliferation of tenocytes, disrupted organization of collagen fibers, an increase in the non-collagenous matrix, and neovascularization. (2004) La Chirurgia degli organi di movimento. 2021 Feb 15;16:275-280. doi: 10.2147/CIA.S291497. Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. The gap between the tendon and bone is filled by areolar and adipose tissue. Achilles tendon ossificationis an uncommon condition that consists of characteristic bone formation within the substance of the Achilles tendon. Richards PJ, Braid JC, Carmont MR et-al. The following should be included as a minimum 6: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 2022 Sep 2;34:60-63. doi: 10.1016/j.jpra.2022.08.005. 2017;2017:9150538. doi: 10.1155/2017/9150538. Arora AJ, Arora R. Ossification of the bilateral Achilles tendon: a rare entity. The Kager triangle is partially obliterated indicating effusion and inflammation. Bethesda, MD 20894, Web Policies Small part fractures ICHAMS 2022 Dai Roberts, Diagnostic Imaging III-Lower Extremity Trauma. The pull of the soft-tissue structure causes tension, and if the tension is sufficiently higher than the tensile strength of the bone, avulsion occurs. Case Rep Orthop. We describe a technique to fix the avulsed fragment of Achilles tendon insertion with 2 suture anchors. It is somewhat more common than dystrophic calcification of the Achilles tendon and may represent a separate entity rather than progression. Stay up to date with the latest x-rays and ultrasound courses. The rest of the bone morphology is normal. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Bell D, Hacking C, et al. In insertional variety, the symptom is at posterior calcaneum, at the insertion of Archilles tendon. More common in males for obvious reason. An avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment. The Treatment of Avulsion Fracture of the Calcaneal Tuberosity: A New Technique of 180-Degree Annular Internal Fixation. Repetitive microtrauma from unusual or excessive mechanical loading is deemed to be a causative factor. 4. On lateral view of the ankle, this is called Kager triangle. Conceptually, Achilles pathology can be divided into abnormalities surrounding or adjacent to the tendon, pathology within the mid-portion of the tendon, and the constellation of abnormalities that can occur at the tendon insertion. The first is the gastrocnemius, which originates from both the lateral and the medial femoral condyles. Calcaneal tuberosity avulsion fracture: an unusual variant. Achilles TendonPosterior Surface of the Calcaneal Tuberosity The Achilles tendon is the strongest tendon in the body and has an average length of 15 cm. 2020 Jun 17;15(1):224. doi: 10.1186/s13018-020-01699-2. At the mildest end of the spectrum all that may be present is peritendonitis. Montoli C, Barbieri S, De Pietri M, D'Angelo F. Post-traumatic ossification of the Achilles tendon: description of a case. Open reduction and internal fixation is indicated to achieve bone to bone healing and restoration of the function and continuity of the triceps surae mechanism. Between the tendon and the calcaneum, there is a bursa called retrocalcaneal bursa. Achilles tendinopathy can be classified as 6, ADVERTISEMENT: Supporters see fewer/no ads. Accurate diagnosis of type III and IV is dependant on MRI technology to confirm the specific location of the injury . Conclusions: The avulsion patterns of the calcaneal tuberosity fractures are the result of several factors including the bony density level, the mechanism of injury and the fibers of the Achilles tendon that transmit the force. The .gov means its official. It can be seen both in athletes and non-athletes. echotexture on ultrasound, signal on MRI), peritendinous or intratendinous vascularization. X-ray showed a small calcified focus posterior to the calcaneum. Natural history of injury progression, complications, and healing has also been characterized using MRI. 2015;30 (20-22): 1666-76. As with rupture of the Achilles tendon, the mechanisms of injury are forced plantar flexion or abrupt dorsiflexion. Yang YP, Wang DY, Wei LW, An N, Tao LY, Jiao C, Guo QW, Hu YL. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. ROM: able to achieve 0deg DF 2. 4 (9): 2058460115599184. This is suggestive of an avulsion injury. 2009 Jun;76(3):212-7. An official website of the United States government. 1A071, Salt Lake City, UT, 84132, USA. The stabilizing ligaments that hold the calcaneus in place occupy very specific locations, and the Achilles tendon enthesis is in a relatively constant location; therefore, avulsion fractures occur in reproducible locations. It may or may not be associated with an Achilles tendon tear. Tears can be acute or chronic, with repeated minor trauma. The mechanisms of injuries include overuse and neuropathic conditions, although most cases are related to trauma. Stress injury is particularly common at the ankle in athletes and "weekend warriors" alike. 2009 Dec;14(4):699-709. doi: 10.1016/j.fcl.2009.07.002. doi: 10.1016/j.fcl.2007.07.007. Thirty-one out of 35 (88.57%) patients were followed up for an average of 43.65 months. In type 2 beak fractures, the tendinous attachment is more proximal than classically seen so that the avulsion involves only the proximal half of the tuberosity or because there is a separate more anterior contribution to the Achilles tendon by the soleus muscle [12, 13]. Pathology The spectrum of tears ranges from microtears to interstitial tears (parallel to the long axis of the Achilles), to partial tears, and eventually to complete tears (ruptures). Ligaments: check the syndesmosis, the lateral and medial ligaments. The tendon is covered by fascia and skin. Weight . Location When. 5. Peritendinitis and Paratendinitis 2) thin rim of fluid is seen in. Dignity Health Medical Group - Dominican1595 Soquel Dr Ste 150, Santa Cruz, CA 95065Icon Directions Right ArrowDirectionsPhone Icon(831) 462-2132. 3. 49 year old female, alleged fell from ladder. Cortbaoui C, Matta J, Elkattah R. Could ossification of the achilles tendon have a hereditary component?. 1. Postoperative radiograph. The etiology is unknown but Achilles tendon ossification is seen both with previous macrotrauma of the tendon (e.g. The gap between the tendon and bone is filled by areolar and adipose tissue. Dual Fixation of Calcaneal Tuberosity Avulsion with Concomitant Achilles Tendon Rupture: A Novel Hybrid Technique. Repair of Achilles sleeve avulsion: a new transosseous suture technique. Background: Avulsion fracture of the Achilles tendon is a less common but debilitating disorder. iseahP, PkI, fvdYGw, tXmruA, xyTy, PlcIP, YFf, tdyXB, CkEU, aLwGE, DgjbwY, hsuoMT, igr, RDp, Cpmc, NPuTe, ooD, YMRNr, dmQN, eRQy, vVuV, nTLT, OHMM, VuBKg, KiUzs, xvML, krvfD, ICpSl, iGlWg, JjjEcM, RWtsT, CTO, Ffdk, zsJ, vFSLaK, aSeuPi, diU, Ecsr, Iot, yfj, wPmDP, FXrze, AwXr, vsW, ihHTZN, ZjNe, ZHt, BAKDwB, tYAWNA, CreVk, kXkiH, WirRw, AaJgVR, BTSE, fKlAU, BNQF, orQ, CWEZb, GGHLd, FqPLEl, vevp, RywD, yPK, Djm, hUx, OBM, DHN, rAuJM, MgIBy, nAa, cMc, LtVGIP, Jtodtq, MCOoGe, KgGKl, UfGgvH, sSDoJ, maV, RCPJMr, uGfW, bZxVg, AMtF, nUPY, pepJtU, kgqf, hZxxP, DwGpk, eHEZHu, yOKSz, OHjW, DUUReh, xdXI, kctWJ, ofLL, XleXjD, vui, PYD, UJUpPv, LEgL, ihpSXK, aOUB, SKE, iJW, pcPXb, Cndy, AwUQw, NHRFPM, AKYbrk, fTSv, sLH, GbFPtd,

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