MB), Help with Avulsion fractures of the tibial spine (also called “tibial eminence fractures” or “ACL avulsion fractures”), leading to discontinuity of anterior cruciate ligament (ACL) fibers, have been well described in the literature in both the pediatric and adult populations. No significant complications, such as arthrofibrosis, loss of initial fixation, or wound infection, were noted. Using a radiofrequency ablator (CoolCut), ablation of the bone edges and removal of clots are performed at the site of avulsion to refresh fracture edges. Avulsion fractures of the anterior cruciate ligament (ACL) from the tibial eminence are rare injuries occurring mainly in children and adolescents. 2019 Oct;29(7):1493. doi: 10.1007/s00590-019-02487-3. Accessory portals and extra instrumentation (suture lasso, cannula) required, 7. The fracture is reduced and fixed, and the tension of the ACL is checked to make sure it is tight in extension and there is no impingement in extension. Share. For displaced (type II/III) fractures, surgical treatment has included fixation with screws, sutures, or wires performed through either open or arthroscopic approaches. Anteromedial view, right knee in 90° of flexion, supine position. This study shows that ACL avulsion fracture can be treated effectively by arthroscopic suture fixation with fiber wires. This article aims to report an interesting case of femoral attachment–ACL avulsion fracture in skeletally mature patient with arthroscopic suture loop … To ensure the stability of the knee joint and good range of motion with minimal to no laxity, surgical reduction of the fracture and fixation are necessary to restore ACL length. Text Edge Style. This videos describes my arthroscopic (keyhole) technique of fixing an ACL avulsed from the tibial end using a Tightrope device. The medial portal is established for shaving and probing, which will show an avulsion of the ACL from the tibial spine. Use of a pullout suture or wiring is the most reported fixation method for femoral-sided avulsion fractures of the ACL. Shaving and ablation are done to clean the anterior surface of the upper tibia to prepare the bed for the anterior anchor. Published by Elsevier. Separation at the femoral attachment is rare 5. © 2019 by the Arthroscopy Association of North America. Using a guided knotted suture anchor, a double-loaded 3.0-mm suture is fixed posterior to the avulsion fracture site. Methods: Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. A tibial eminence fracture, also known as a tibia spine fracture, is an intra-articular fracture of the bony attachment of the ACL on the tibia that is most commonly seen in children from age 8 to 14 years during athletic activity. Can be used for acute and chronic cases, Redistribute or republish the final article, Translate the article (private use only, not for distribution), Reuse portions or extracts from the article in other works, Distribute translations or adaptations of the article. Tibial spine fractures are characterized by fractures at the insertion site of the anterior cruciate ligament (ACL) on the tibia and were first classified into 3 types. 2019, Received: The far medial portal is established for suture management and reduction of the fracture. Copyright © 2021 Elsevier B.V. or its licensors or contributors. We describe a technique using 2 anchors to fix the fractured tibial spine with no need to make any tibial tunnels or any extra leg wounds for the sutures. Tap to unmute. Full ICMJE author disclosure forms are available for this article online, as supplementary material. 2019. ACL AVULSION FRACTURE AND SUTURE FIXATION e685. Reduction of the avulsed piece by probing is tried. OBJECTIVE: To evaluate the clinical results of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures in adolescents with epiphyseal unclosure. Pearls and pitfalls of this technique are explained in. J Knee Surg DOI: 10.1055/s-0040-1722347A wide variety of fixation methods have been reported to fix anterior cruciate ligament (ACL) tibial avulsion fractures, but there have been no studies into the fixation of these fractures with ultra-high molecular weight polyethylene (UHMWPE) suture tape as an alternative to conventional thread. Tibial spine avulsion fractures are rare and occur mostly in age group 8 -14 years [1], though there is increase in the number of this injury in adults has been noted recently [2-4]. Optimal treatment methods remain … Unlike ACL injuries, bony avulsion of PCL is common. Post-operative displacement of fracture fragments did not take place among the patients involved in the study. Normal diagnostic arthroscopy to the knee is performed starting from the high anterolateral portal. The fixation technique employed is crucial to the success of the fixation of ACL tibial eminence avulsion fractures. Using a guided knotted suture anchor, a double-loaded 3.0-mm suture (SutureTak; Arthrex) is fixed posterior to the avulsion fracture site. Various arthroscopic fixation techniques have been reported for tibial eminence avulsion fractures, and fixations with screws and sutures are the most common methods at present. Fig 1: Classification system of tibial eminence fractures. METHODS: This prospective study analyzed 36 patients who underwent arthroscopic reduction and suture fixation for image-proven ACL avulsion fractures of the tibial eminence. From the same portal, an 8-mm passport cannula (Arthrex) is introduced. Kawate et al. 2 reported the case of a 3-year-old boy who presented with a femoral-sided osteochondral avulsion fracture of the ACL. The surgical treatment options for ACL tibial avulsion fractures are open or arthroscopic fixation. Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be reduced. 5 Ethibond sutures can restore ACL length, stabilize fragments, promote early motion, and minimize morbidity. It may restore knee function and stabiity. 5 Ethibond sutures can restore ACL length, stabilize fragments, promote early … If playback doesn't begin shortly, try restarting your device. Copy link. All our patients with displaced ACL avulsion fractures achieved excellent functional and stability outcomes after avulsion fracture fixation, with a mean follow up of 24 months. Tibial spine avulsion fractures are uncommon knee injuries that predominantly occur in children and young adults. Anterior cruciate ligament (ACL) avulsion fracture or tibial eminence avulsion fracture is a type of avulsion fracture of the knee. If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. Font Family. For displaced (type II/III) fractures, surgical treatment has included fixation with screws, sutures, or wires performed through either open or arthroscopic approaches. Using a guided knotted suture anchor, a double-loaded 3.0-mm anchor (SutureTak; Arthrex) is fixed posterior to the avulsion fracture site. These fractures are also called as tibial eminence fractures or ACL avulsion fractures. A total of 27 patients (13 males and 14 females) who underwent arthroscopic "figure-of-eight" suture-button fixation for displaced ACL avulsion fractures were analyzed. Purpose: To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading. tunnels just outside the bony crater.12 However, all these solutions provide 2-point fixation, and this might explain the finding of slight postoperative laxity.1 Only 1 recently published study proposed 3-point fixation in cases with anterior-horn lateral meniscus lesions.7 Our study supports 4-point stabilization that allows the … Avulsion fractures of tibial spine, leading to discontinuity of anterior cruciate ligament fibers has been well described in literature in both pediatric and adult population. Tran Trung Dung, Hoang Gia Du, Nguyen Hoang Long, Le Manh Son, Dao Xuan Thanh, Dinh Ngoc Son, Nguyen Tuyen, Do Van Minh, Nguyen Huy Phuong, Vu Tu Nam, Pham Trung Hieu, Ma Ngoc Thanh. This technique uses 4 arthroscopy portals: anteromedial (just medial to the patellar tendon) (viewing portal); high anterolateral and far medial (working portals); and high anteromedial suprapatellar (accessory portal) for posterior anchor placement. Font Size. Anteromedial view, right knee in 90° of flexion, supine position. assisted ACL tibial avulsion fracture fixation with fibre wire and Endobutton using simple instrumentation. Type I, nondisplaced or … The tension of the ACL is checked to make sure it is tight in extension and there is no impingement in extension. To update your cookie settings, please visit the, A Technique Utilizing GraftNet to Fill Graft Donor Sites in Bone-Patellar-Bone Anterior Cruciate Ligament Reconstruction, Roux-Goldthwait and Medial Patellofemoral Ligament Reconstruction for Patella Realignment in the Skeletally Immature Patient. There were no meniscal nor PCL injuries. Anteromedial view, right knee in 90° of flexion, supine position. Restoration of anterior cruciate ligament length through surgical reduction and fixation of the fracture is necessary to ensure stability of the knee with suitable range of motion and minimal knee laxity. We use cookies to help provide and enhance our service and tailor content. The authors report that they have no conflicts of interest in the authorship and publication of this article. This prospective study involves 28 patients, who underwent arthroscopic fixation of displaced ACL avulsion fractures at Saint Paul Hospital (Hanoi) from January 2014 to March 2018. They represent a variant of anterior cruciate ligament injury. This technical note presents a method for primary anatomic ACL reinsertion for an acute distal soft-tissue avulsionetype ACL injury, using Correction to: Arthroscopic fixation of ACL avulsion fracture in the Saint Paul Hospital: a review of treatment outcomes. In fact, this technique may restore knee function and stability. Fixation of this type of fracture is necessary as they The main drawbacks of the open approach are difficulties in viewing the fracture and treating the associated meniscal or chondral injuries. The surgical treatment options for ACL tibial avulsion fractures are open or arthroscopic fixation. Anteromedial view, right knee in 90° of flexion, supine position. tissue avulsion of the ACL is a rare and challenging condition. Avulsion fracture of the anterior cruciate ligament (ACL) is seen in pediatric patients and infrequently in adult patients. Avulsion fractures of tibial spine, leading to discontinuity of anterior cruciate ligament fibers has been well described in literature in both pediatric and adult population. Here we describe a technique using 2 anchors to fix the fractured tibial spine with no need to make any tibial tunnels or any extra leg wounds for the sutures. The avulsion site is exposed by shaving, and the ACL is probed. Eur J Orthop Surg Traumatol. image, Download .pdf (1.09 Up Next. Evaluating the results of arthoscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture. None Raised Depressed Uniform Dropshadow. Info. From the same portal, an 8-mm passport cannula (Arthrex) is introduced (, The sutures coming out of the posterior anchor are loaded through a pushlock anchor (knotless) size 3.5 mm (Arthrex), and the anchor is fixed to the anterior part of the tibia using a double-row technique (, Accepted: Restoration of anterior cruciate ligament length through surgical reduction and fixation of the fracture is necessary to ensure stability of the knee … The far medial portal is then made for suture management and reduction of the fracture. Anterolateral portal, right knee in 90° of flexion, supine position; use of periosteal elevator to elevate the fracture tibial piece. Loading of the sutures coming out of the posterior anchor with a pushlock anchor (knotless) size 3.5 mm (Arthrex). 50% 75% 100% 125% 150% 175% 200% 300% 400%. In this article, we discuss the clinical and imaging findings of avulsion fractures of the ACL and PCL, as well as an … Avulsion fracture of femoral attachment of ACL was uncommon and mostly reported in skeletally immature patient. Abstract. July 23, Tibial spine or anterior cruciate ligament (ACL) bony avulsion is not an uncommon injury. Patients with a tibial spine avulsion will present with a swollen and painful knee with an inability to bear weight on the affected extremity. Anteromedial view, right knee in 90° of flexion, supine position. Posterior anchor is inserted and secured. Patient is placed supine on the operating table under general anesthesia with an upper thigh tourniquet and the knee in 90° flexion on the table. To date, ACL treatments for many displaced tibial avulsion fractures have been reported to yield poor clinical results, either with limited knee extension or slight anterior knee instability 15 - 18 . The mean follow-up period was 34.4 months (range, 24 to 91 months). Painting is done from the end of the tourniquet to the foot, and then toweling is performed. The ACL avulsion fracture can be treated effectively by arthoscopic suture fixation with fiber wires. This study shows that ACL avulsion fracture can be treated effectively by arthroscopic suture fixation with fiber wires. The knee is placed in a functional brace in extension while isometric strengthening exercises are initiated immediately. Address correspondence to Ziyad Elqirem, Orthopaedic Surgery, Specialty Hospital, 9 Ibin Khaldoon Street, Zain Complex, 1st Floor, Amman 11196, Jordan. Avulsion fractures of the tibial spine, leading to discontinuity of anterior cruciate ligament (ACL) fibers, have been well described in the literature in both pediatric and adult populations. Arthroscopic fixation of ACL avulsion fracture … Four portals are anteromedial, high anterolateral, far medial, and high anteromedial suprapatellar. The classification of Meyers and McKeever identified 6 type II, 16 type III, and 14 type IV fractures. In fact, this technique may restore knee function and stability. No meniscal or intermeniscal ligament tissue was found in the fracture bed. Arthroscopy-Assisted Management or Open Reduction and Internal Fixation of Tibial Spine Fractures Itai Gans Theodore J. Ganley DEFINITION Tibial spine fractures are bony avulsions of the anterior cruciate ligament (ACL) from its attachment on the antero-medial portion of the intercondylar tibial eminence.26 Some authors consider them to be equivalent to the midsubstance ACL … These fractures are also called as tibial eminence fractures or ACL avulsion fractures. A large osseous fragment was found attached to ACL (Figure 4), with no comminution. This typically involves separation of the tibial attachment of the ACL to variable degrees. We use cookies to help provide and enhance our service and tailor content and ads. The knee is then placed in 30° extension, and from the same portal, the anterior surface is prepared for anchor placement. Anterior cruciate ligament (ACL) avulsion fracture is rare and mostly occur in tibial attachment. Various arthroscopic fixation techniques have been reported for tibial eminence avulsion fractures, and fixations with screws and … pdf files, Mobilization of bony avulsion and preparation, Panoramic view is obtained of the fracture site arthroscopically, Sometimes difficult to mobilize the fractured bone arthroscopically, Posterior fixation to the fracture gives more anatomic reduction and more stability, Technically demanding to place the anchor; needs an accessory portal, Sutures are passed through the bone and ACL itself anteriorly and posteriorly, Technically demanding to pass suture through the bone; needs special instruments to pass the suture (suture lasso); requires use of a cannula (increased cost), Adds more stability and anatomic reduction, Extra cost; difficult visualization of the anterior cortex below tibial plateau; should be a knotless anchor, 3. 1 In 1959, Meyers and McKeever 2 proposed a classification system for these fractures, according to which type I fractures are nondisplaced; type II, or “bird-beak,” fractures produce displacement of the anterior margin … Using a 45° lasso curved to the left, the ACL and the avulsed bone are sutured. However, in the follow-up, non-union of the tibial spine was diagnosed and surgical fixation of the bone fragment with screw was needed. You will then receive an email that contains a secure link for resetting your password, If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password. It primarily occurs during sports activities and trauma. After loading the sutures coming out of the posterior anchor through a pushlock anchor (knotless) size 3.5 mm, the anchor is fixed to the anterior part of the tibia using a double-row technique. The main drawbacks of the open approach are difficulties in viewing the fracture and treating the associated meniscal or chondral injuries. Tibial spine fractures are characterized by fractures at the insertion site of the anterior cruciate ligament (ACL) on the tibia and were first classified into 3 types. The anchor is fixed to the anterior part of the tibia using a double-row technique. Avulsion fractures of the tibial spine (also called “tibial eminence fractures” or “ACL avulsion fractures”), leading to discontinuity of anterior cruciate ligament (ACL) fibers, have been well described in the literature in both the pediatric and adult populations. The purpose of this research is to evaluate the results of arthroscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture, and to determine how effective such a technique is when it comes to restoring of knee function. Arthroscopic fixation of tibial spine avulsion fracture in open physis. 2019Oct;29(7): 1485-1491. Treatment of cruciate ligament avulsion fractures includes immobilization for undisplaced fractures and surgical fixation for displaced fractures, although to our knowledge, there is no evidence based research on the treatment of these injuries. DOI: https://doi.org/10.1016/j.eats.2019.07.030. METHODS: Between January 2011 and October 2013, 35 knees with ACL tibial eminence avulsion fractures (35 patients with epiphyseal unclosure) were arthroscopically treated with suture fixation… The ACL is probed to assess the tension and to check whether the femoral attachment of the ACL is intact. The fixation technique employed is crucial to the success of the fixation of ACL tibial eminence avulsion fractures. In the case presented, when Type II avulsion fracture of the tibial spines was diagnosed without involvement of the ACL or the meniscus, the first choice was conservative treatment. Displaced injury leads to PCL deficiency & hence disability & pain. © 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. https://doi.org/10.1016/j.amsu.2019.07.008. … Multiple techniques have been described for fixation of these fractures. Then 1 limb of the suture is passed through the posterior part of the bone and the other limb through the posterior part of the ACL. Figure 5(a-c): ACL and PCL avulsion fracture of the right knee in a 47 year old male fixed with screws for PCL and staples for ACL - "Displaced anterior cruciate ligament avulsion fractures: Arthroscopic staple fixation" Dr Ali Alsmair and Dr Yuranga Weerakkody et al. They represent a variant of anterior cruciate ligament … Viewing from the anterolateral portal, a periosteal elevator is used to elevate the fractured tibial piece (, With the knee in 90° flexion and viewing from the medial portal, the accessory high anteromedial suprapatellar portal is established for inserting the anchor 45° to the tibial plateau. CONCLUSIONS: Treating ACL avulsion fracture by arthroscopic suture fixation by use of 4 No. Arthroscopic fixation of ACL avulsion fracture in the Saint Paul Hospital: a review of treatment outcomes. This injury is also associated with laxity of the ACL as it is the site of the attachment of the ACL [5]. In cases with isolated ACL avulsion fractures, a standard postoperative rehabilitation protocol is followed. May 28, X-rays will show an avulsion fragment of the tibia. The first three weeks were not marked with any abnormalities associated with post-operative sutures and hematomas, infectious complications were not detected either. The purpose of this study was to assess the clinicoradiological outcome of patients with ACL avulsion fractures (type 2 to type 4) fixed arthroscopically using fibre wire and Endobutton. All our patients with displaced ACL avulsion fractures achieved excellent functional and stability outcomes after avulsion fracture fixation, with a mean follow up of 24 months. Arthroscopic reduction of tibial spine avulsion: suture lever reduction technique. However, there is insufficient evidence to support the superiority of the arthroscopic approach in terms of healing, motion … Diagnosis can be made with radiographs alone; computed tomography or magnetic resonance imaging is useful to determine the size of the fragment and any associated injuries. Please enter a term before submitting your search. reduction, evaluation and fixation of tibial spine avulsion fracture. Anteromedial view, right knee in 90° of flexion, supine position. Maintaining the knee in 90º of flexion, the medial tibial spine was temporarily … Tran Trung Dung, Hoang Gia Du, Nguyen Hoang Long, Le Manh Son, Dao Xuan Thanh, Dinh Ngoc Son, Nguyen Tuyen, Do Van Minh, Nguyen Huy Phuong, Vu Tu Nam, Pham Trung Hieu, Ma Ngoc Thanh. The percentage of excellent scores was 42.9% (12 patients), good scores accounted for 50% (14 patients), while fair/poor scores accounted for 3.6% each (1 patient on each score). Treating ACL avulsion fracture by arthroscopic suture fixation by use of 4 No. Arthroscopic fixation of ACL avulsion fracture in the Saint Paul Hospital: a review of treatment outcomes. The purpose of this article is to describe the fixation of tibial spine avulsion by a simple technique using inexpensive intravenous cannula needle and high-strength nonabsorbable suture, which allows accurate reduction and rigid fixation of fracture. Unlike femoral-sided ACL repair, surgery for acute tibial-sided ACL ruptures has been neither reported nor described. Patient is placed supine on the table with foot over the table, knee flexed at 90°. The percentage of excellent/good scores was 92.9% in total. ACL avulsion treated with Arthroscopic Screw fixation. Thus, it can be recommended for acute injuries. Shopping. Several arthroscopic techniques have been described to reduce and fix these fractures. The present study aims to evaluate the clinical outcome of arthroscopic suture bridge fixation technique. Using a periosteal elevator to elevate the fracture tibial piece, ablation of the bone edges and removal of clots are performed at the site of avulsion to refresh the fracture edges. At the 3-month follow-up, the average IKDC score was 90.7 (range: 76–100), and the average Lysholm score was 93.6 (range 82–100). ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Arthroscopic fixation of ACL avulsion fracture in the saint pault hospital: A review of treatment outcomes: Cohort study, Anterior cruciate ligament avulsion fracture. Image, Download Hi-res Tibial Spine Avulsion Fractures: Overview and Arthroscopic Technique for Internal Fixation with Cannulated Screws Benedict U. Nwachukwu Daniel W. Green INTRODUCTION Children and adolescents are increasingly involved in competitive sporting activities, and as such, there continues to be a need to understand the sport-related injuries affecting the pediatric age … Lachman or anterior drawer tests may be positive, as with an ACL tear, but the pain can make it difficult to perform a proper physical examination of the affected knee. Watch later. Department of Orthopaedic Surgery, Specialty Hospital, Amman, Jordan. With a 45° lasso (Arthrex) curved to the left, 1 limb of the suture is passed though the anterior bone side and the other limb through the anterior fibers of the ACL. Purpose: Numerous techniques for treatment of anterior cruciate ligament (ACL) avulsion fractures have been described in literature from closed reduction to definitive fixation, both open and arthroscopically assisted fixation. Poncet in 1895 was probably the first person to document However, there is insufficient evidence to support the superiority of the arthroscopic approach in terms of healing, motion … Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque. According to Meyers-McKeever classification, 11 patients were classified as type III … By continuing you agree to the use of cookies. Eur J Othop Surg Traumatol. Avulsion fractures of the tibial spine (also called “tibial eminence fractures” or “ACL avulsion fractures”), leading to discontinuity of anterior cruciate ligament (ACL) fibers, have been well described in the literature in both the pediatric and adult populations. Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps. The key point is accurate reduction and rigid fixation, ensuring no impingement on full extension CONCLUSIONS: Mini-open fixation allows accurate, anatomic reduction and stable fixation with screws, and should be the preferred method of fixation for late presenting ACL avulsion fractures; embedding the fragment deep into the crater or size reduction are key to preventing extension … Tibial spine avulsion fractures are uncommon knee injuries that predominantly occur in children and young adults. This fracture was operatively treated with the medial parapatellar approach and fixation with pullout metal wiring … eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIwYzE4MGJkODVjNTkxMjEwMjdlNzMwMjg5NmQ2NTJjZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjIxNjc1MjUxfQ.UGiPzOORoC6wMZRx8EF7ZlPvrj4sZeTsl9gym8IbXZDMfQ90lV3IzExnLttWbMFjuDGaJIJe8zgOI5HRwHCyfPLekSmh3n_3ZhWUckd5xY3r6QSjn3InlqLcr-d3chlGyOX_NNe6cZ6VHNoLqH9vRshaXGpJ2qRFnOcDX8JnPVfC9BF3POLNOFGCr3XCGidH12Ky-dyS-LW6Yzpz1HNG43lDKlTdvtiJTqldmYsss4k5FIEffTHAkpZfZBgPdmerpcCo8jMM-u9AUsnHaHcnCuEOhTwmCmF9Lv0YaotyMMc9k1zQGjIDylb2WmoFdOLrzW-WU6O_wwG6BAQAkbtrow, Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0), https://doi.org/10.1016/j.eats.2019.07.030, Double-Row Fixation for Avulsion of Anterior Cruciate Ligament, View Large Do tibial eminence fractures and anterior cruciate ligament tears have similar outcomes?. The mean age of the patients in the sample was 15.8 years (10-29 years), with a mean follow-up of 24 months (6-48 months). To ensure the stability of the knee joint and good range of motion with minimal to no laxity, surgical reduction of the fracture and fixation are necessary to restore ACL … Anterolateral view, right knee in 90° of flexion, supine position. Arthroscopic knot tying of the suture. Anteromedial view, right knee in 90° of flexion, supine position. With the knee in 90° flexion, from the accessory high anteromedial suprapatellar portal, we insert the anchor 45° to the tibial plateau. 1.
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