Its not common to see femoral fractures with a patella dislocation and this indicates how forceful the dislocation must have been. 29515-RT Splint, leg, short Note: E/M code 99283-25 is applicable in this case. US showed acute injury to the lateral . This is a 14 year old patient with history of fall. 10021. When the medial patellar ligament ruptures, it is typically caused by the lateral dislocation of the patella. Patellar instability, or unstable kneecap, is a common condition of the medial patellar ligament where the kneecap is out of its proper place. There is bone marrow edema involving the medial side of the patella and lateral side of the femoral condyles with thickening and high signal seen in the medial retinaculum. Medial Patellofemoral Ligament (MPFL) Tear X. Inhomogeneously fibrillar MPFL indicating high-grade rupture, resultant soft tissue edema. A dislocating patella in a patient eight years of age is demonstrated in Figure 1. [1] Epidemiology/Etiology A ligament is a type of, The lateral meniscus is attached to the shin and is located on the outer side of the knee. Not all the 150 patients had a complete roentgen examination, including tangential views, and therefore the exact statistical occurrence of the marginal fracture could not be established. On X-ray we can't say defnitely that it's a hemarthrosis but the presence of a fracture would indicate that it is likely to be a hemarthrosis. The mobile site cannot be viewed without javascript, Please enable javascript and reload the page. 27514-LT Fracture, femur, distal 7. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Fracture of lateral and medial malleoli as well as posterior lip of distal tibia . Bethesda, MD 20894, Web Policies 1, Vastus medialis muscle. Computed tomography (CT) CT is not a first-line imaging modality for diagnosing patellar dislocation. If the patella is dislocated on arrival adequate analgesia should be given (penthrane or N2O) and the knee gently extended, with medial pressure on the patella, until the dislocation is reduced. Download Citation | On Dec 1, 2022, V.S. in Obesity) Knee Dislocation is a risk for vascular injury, and missed dislocation risks limb loss XI. On postoperative MRI, it appears as an area of defect on the central third of the patellar tendon after the surgery. As the knee bends (flexion) from a fully straightened position, the patella descends into the trochlea, but does not fully enter this groove until approximately 20-30 of knee flexion. . One of the bones has been forced backward or forward relative to the other bone. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. A history of previous trauma was obtained in 12. STGT reconstruction uses semitendinosus and gracilis tendons as autografts. In a few instances, we have been able to diagnose this previous dislocation from the x-ray examination without knowledge of the patient's history or clinical findings. Last medically reviewed on January 22, 2018. It is situated deep to the vastus lateralis muscle, ranging from the posterior aspect of the medial femoral condyle to the superomedial part of the patella, vastus medialis and quadriceps tendon. The patient has had a recent patella dislocation and there is now a large suprapatellar effusion (on MRI this was a hemarthrosis). When the medial patellar ligament ruptures, it is typically caused by the lateral dislocation of the patella. Additional passive stabilizers include the medial patellotibial ligament (MPTL) and the medial patellomeniscal ligament (MPML). This means the kneecap is displaced off to the side, which often occurs as the result of falls or sports injuries. Order now. These results suggest that the OA unloader brace may reduce medial compartment joint loading during dynamic loading activities. Here the fracture is purely chondral in nature and therefore invisible. 1 Department of Radiology, Veterans Affairs Medical Center, University of . and faculty focus upon the best practices for analyzing a wide range of MSK anatomy, through the use . Assessment of Patellar Dislocation: Assess neurovascular status distal to the patellar The apprehension test can be used to assess for patellar dislocation and subluxation. $ 30.00. All three patients had undergone a lateral retinacular release to the involved . The purpose of this presentation is to discuss and illustrate the roentgen abnormalities which follow lateral dislocation of the patella and to point out the importance of the tangential view of the patella in the examination of the knee. Tap on the below button when you are Online. . First-time patellar dislocation typically occurs with twisting knee motions, during which the medial ligamentous stabilizers rupture, and the patella strikes against the lateral femoral condyle. The aim of this paper was to determine the influence of smoking on functional outcomes after isolated all . Radiographic and MR imaging findings in injuries of the posterolateral corner of the knee may suggest injury to specific . 3, 1 December 2002 | Radiology, Vol. The two fundamental maneuvers for patellar relocation are extension of the knee and mild medial stress applied to the patella while lifting the most lateral fringe of the . US showed acute injury to the lateral patellar retinaculum with complete avulsion at its patellar insertion. All rights reserved. 17 Magnetic resonance images acquired at 1.5 T or 3 T allow the radiologist to visualize internal . Of the 16 patients in whom the medial marginal fracture of the patella was demonstrated, the youngest was twelve years of age. Knee Case Review - Root Tear - Outer 3rd and Middle 3rd 5 min. The third edition of A Comprehensive Review of Musculoskeletal MRI provides a thorough review and update of techniques and protocols in this specialized imaging area. The typical injury pattern is a tear of the medial patellofemoral ligament (MPFL) and bone bruises of the patella and the lateral femoral condyle. 6, No. Knee: Medial Meniscus Attachments on MRI 6 min. 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 means the kneecap is displaced off to the side, which often occurs as the result . 174, No. In two-thirds of cases, it concerns young active subjects under . The medial patellofemoral ligament is the primary stabiliser (53-67%) against lateral displacement/dislocation of the patella. These fibers attach and course from the superficial medial collateral ligament toward the patellar bone, or kneecap. Another radiologic study by Elias et al 7 based on MRI analysis documented lesions of the lateral femoral condyle in 80% and lesions of the medial patella in 61% of all cases, with intra-articular loose bodies in 15%. Check for errors and try again. 225, No. It is usually an iatrogenic complication of surgical lateral retinacular release. This condition can result in pain, swelling, and difficulty using the knee. 27562-RT Dislocation, patella, closed treatment 6. The laterally dislocated patella locks itself over the lateral margin of the lateral femoral condyle; then, upon contraction of the quadriceps, the patella is pulled back into its normal position. The superficial medial collateral ligament connects the bottom of the femur (thighbone) to the top of the tibia (shinbone). 1, EMC - Radiologie et imagerie mdicale - Musculosquelettique - Neurologique - Maxillofaciale, Vol. The medial ossification can be seen within the MPFL or the medial joint capsule, suggesting remote injury to these structures. 5, Greater saphenous vein. We describe the clinical, ultrasound (US), and magnetic resonance (MR) imaging features of a transient medial patellar dislocation in a 19-year-old patient with trochlear groove dysplasia presenting no surgical history. 4, Tractus ilio-tibial 5, Posterior cruciate ligament. . Young man with recent trauma to the knee and ongoing pain. The severity of injury depends on the type and strength of current and ranges from a barely perceptible tingling sensation to instant death. ADVERTISEMENT: Supporters see fewer/no ads. During four academic years (1974-1978) at a major university, 51 of 70 knee injuries sustained by football players were Grade I or II sprains of the medial collat eral ligament of the knee. The PFL and arcuate ligament were seen to attach directly to the posterior and medial aspect of the styloid process of the fibular head. Surgical procedures of the percutaneous lateral release and medial reefing for recurrent patellar dislocation of the left knee. PATELLA DISLOCATION SUBLUXATION FRACTURE HEMARTHROSIS LIPOHEMARTHROSIS MRI KNEE RADIOLOGY - Radedasia PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE DISCUSSION ON PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE WHAT ARE THE XRAY FINDINGS? There is bone marrow edema involving the medial side of the patella and lateral side of the femoral condyles with thickening and high signal seen in the medial retinaculum. Knee Case Review: Medial Meniscus Attachments on MRI 5 min. 211 . The ligament ruptures at the femoral (thighbone) origin in most cases. The femoral artery is one of the major arteries in the human body. Exercise 4.19 Musculoskeletal System 1. The patellofemoral indexis the ratio between the thickness of the medial joint space and the lateral joint space (L). relation to patellar dislocation. 2003;85-A suppl 2:58-69. with knee injuries. It extends from the patella, otherwise known as the kneecap. Ecchymosis was also noted on right side of the body over the knee, thigh, and shoulder. Early recognition of bone bruising of the patella and lateral femoral condyle, associated osteochondral injuries, and medial patellar stabilizer injury is important for timely diagnosis. There is also a bone contusion of the inferomedial patella. Risk factors for recurrent patellar dislocations include 5: trochlear dysplasia patella alta increased patellar tilt increased femoral internal rotation A patella dislocation is a dislocation of the knee cap. Medial patellofemoral ligament injuries can be classified based on the type and/or location 1,6-8. Common indicators of this rupture are pain and tenderness in this ligament near the medial retinaculum, along the inner side of the knee. A further subclassification can be made based on the type of injury at the patellar insertion site: ligamentous, bony avulsion or osteochondral injury 1. Radiographs should be obtained to document reduction. In addition there is also a grade 1strain of the medial collateral ligamentand a large joint effusion. Home Musculoskeletal radiology Lateral patellar dislocation Lateral patellar dislocation Tuesday, August 30, 2016 Musculoskeletal radiology Lateral patellar dislocation is lateral displacement followed by dislocation of patella due to disruptive changes to the medial patellar retinaculum. decrease in the rate of medial meniscus repairs relative to medial meniscus injury was associated with delayed time to Jungmann et al, 77 in a study of 88 . This disorder can be disabling to the patient and may require a hospital visit for reduction. In 16 cases, 12 females and 4 males, the fracture of the medial articular margin of the patella was demonstrated. CLICK ICON BELOW TO SEE ALL OUR INSTAGRAM POSTS, MORE WHAT'S THE Dx POSTS: CLICK THE IMAGE BELOW, RETROCALCANEAL BURSITIS RADIOLOGY MRI ANKLE, KNEE PLICA MRI MEDIAL PATELLAR PLICA RADIOLOGY. Radiology . Find the code on the page and enter it above. Meniscal Untethering/Extrusion 4 min. It, The posterior cruciate ligament (PCL) is one of four ligaments that hold the knee in place and provide added stability. It is about eight to ten centimeters long and stretches from, The fibular collateral ligament is one of the ligaments that make up the knee joint. We describe the clinical, ultrasound (US), and magnetic resonance (MR) imaging features of a transient medial patellar dislocation in a 19-year-old patient with trochlear groove dysplasia presenting no surgical history. If the address matches an existing account you will receive an email with instructions to reset your password. Use of this site is governed by our, DISCUSSION ON PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE. Unknown Knee Case: Pediatric Meniscus Injury 6 min. highest paid pediatric jobs; instacart bot batch . From the case: Chondral delamination - knee. The patellofemoral compartment is part of the knee joint and is formed by the patella and the groove (femoral trochlea) at the lower (distal) end of the thigh bone. PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE: MOVE SLIDER ICON TO VIEW At that point there are three landmarks: the inferomedial geniculate artery and paired veins (figure). All were managed identically with an active rehabilitation program involving partial or no immobilization. Patellar instability may be treated with nonoperative management in the beginning, such as immobilization and special exercises. Medial patellar ossification correlates with a history of prior patella subluxation and/or dislocation. The medial patellar ligament originates at the medial epicondyle (an area of bone at the top of the femur) and medial collateral ligament (MCL), an important ligament located on the inside of the knee. This ligament is almost always torn with patellar dislocations. BTB reconstruction is performed with the patellar tendon along with two bone fragments. Smoking is an important factor predicting poor outcome in orthopedics; however, data about its role in meniscus surgery are inconclusive. The sensitivity and specificity of ultrasound for Achilles tendon rupture, as reported within the radiology literature, are 96% to 100% and 83% to 100%, respectively. web1! (CVA) in association with a Taser-induced electrical injury," Emergency Radiology, vol. Author(s), Article title, Publication (year), DOI. Large joint effusion. . If that doesnt work, surgeries may be performed, which can require the realignment of the patella. Intra-articular Platelet-Rich Plasma vs Placebo Injection and Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis | JAMA | JAMA Network To the Editor A recent study found that intra-articular injection of platelet-rich plasma (PRP) did not significantly improve symptoms or joint structure at 12 [Skip to Navigation] Afracture or cortical irregularity of the medial articular margin of the patella was noted in a number of patients admitted to The Hospital for Special Surgery, New York, with the diagnosis of recurrent lateral dislocation of the patella. Medial femoral condyle fracture (Green Arrow), PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE, PATELLA DISLOCATION SUBLUXATION HEMARTHROSIS FRACTURE: MOVE SLIDER ICON TO VIEW, IMAGES ARE FROM OUR INSTAGRAM ACCOUNT. Nayak and others published Morphological Study of the Transverse Ligament of Knee Joint in Embalmed Cadavers | Find, read and cite all the research you . This is due to the dislocation, with the patella hitting against the femur to cause the fracture. The joint most commonly evaluated with MRI is the knee: noncontrast 1.5 T and 3 T MRI have replaced diagnostic knee arthroscopy, which was still performed in large numbers at the beginning of this century in patients with unclear symptoms. 24516-RT Fracture, humerus, shaft Exercise 4.18 Musculoskeletal System 1. Additionally a fracture fragment is present adjacent to the medial femoral condyle. Damage to medial stabilizers leads to recurrent patellar dislocation, especially if there are additional anatomical risk factors such as . #radiology #radedasia #mri #kneemri #msk #mriknee #mskmri #radiologyeducation #radiologycases #radiologist #rads #radiologystudent #radiologycme #radiologycpd #medicalimaging #imaging #radcme #rheumatology #arthritis #rheumatologist #sportsmed #orthopaedic #physio #physiotherapist #patelladislocation #patella #patellasubluxation, This site is intended for Medical Professionals only. 5, 2022 Radiological Society of North America, Acute Lateral Patellar Dislocation at MR Imaging: Injury Patterns of Medial Patellar Soft-Tissue Restraints and Osteochondral Injuries of the Inferomedial Patella1, The Hospital for Special Surgery 535 East 70th Street New York, N. Y. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Patellar dislocation. MRI has been found to be 85%-92% sensitive for diagnosing MPFL injury (Seeley, 2013). Afracture or cortical irregularity of the medial articular margin of the patella was noted in a number of patients admitted to The Hospital for Special Surgery, New York, with the diagnosis of recurrent lateral dislocation of the patella. Report Report even the absence of dislocation or fracture. Ligaments are bands of fibrous, durable tissue that connect and, The oblique popliteal ligament crosses the back of the knee joint. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. 14.1 ). US is not a first-line imaging modality for patellar dislocation; however, it may be used to detect medial patellofemoral ligament injury during the postreduction follow-up period. The medial patellar ligament is a connective tissue that consists of transverse fibers (fibers that run horizontally). The medial patellofemoral ligament is composed of a transverse (T) component arising between the adductor tubercle and medial epicondyle and an oblique decussation that originates from the medial collateral ligament (MCL). Records of 150 patients admitted to the hospital with a diagnosis of lateral dislocation of the patella were obtained, and their roentgen examinations and charts reviewed. It is a thin, circular layer of tissue that. Healthline Media does not provide medical advice, diagnosis, or treatment. Three cases are presented in this article in which computed tomography demonstrated the dislocation. The bony structure of the patellofemoral joint is another static stabilizer, especially during deeper knee flexion angles. This C-shaped, rubbery, cartilage plays a key role in. ray you need to do a horizontal view with the patient lying down in order to see the fat fluid level. patellar restraints (81% of patients). 6, Gracilis muscle. Description. With the knee 20 flexed, it should measure 1.6 or less. . Medial dislocation of the patella is an unusual entity. In a normal trochlea (a), the patella (sphere), guided by forces from the quadriceps tendon, patellar tendon, and medial and lateral supporting structures (red arrows), begins each cycle of knee flexion by entering the shallowest, most proximal portion of the trochlea (upper portion of diagram). A concurrent finding also previously described (14), the compression fracture or irregularity of the lateral margin of the lateral femoral condyle, was seen in only a few cases. Diagnosis is made clinically with careful assessment of limb neurovascular status. Musculoskeletal conditions are an extremely common presentation to general practitioners, emergency departments and hospitals. [1] Also, look for: Any resultant fractures of the patella Knee effusion, seen as increased space under the patella. 17, No. Not done in this case. The medial patellar ligament is located in the second layer of the knee. 2, Quadriceps tendon. Inhomogeneously edematous lateral vastus muscle compartment indicating simultaneous muscle injury. The tibial collateral ligament is also called the superficial medial collateral ligament. 5. a Percutaneous lateral release using Metzembaum scissors.b The vastus medialis oblique muscle and medial retinacular complex advanced over the quadriceps tendon and border of the patella, with 5-10 mm of overlap depending on the arthroscopic finding of patellar . Knee dislocations are high energy traumatic injuries characterized by a high rate of neurovascular injury. Study free Radiology flashcards about RAD Pathology created by bre092795 to improve your grades. Conclusion: Cartilage shearing injury involving the posterior aspect of the lateral femoral condyle. 2005-2022 Healthline Media a Red Ventures Company. The presence of this lesion will prompt physicians to evaluate for patellar instability. in stock. The medial patellofemoral ligament (MPFL) is the primary static restraint to lateral patellar instability during the first 20 degrees of knee flexion. 2, pp. Its primary function is to supply blood to the lower section of the body. The impingement of the medial margin of the patella upon the lateral condyle causes a compression defect in the condyle and a fracture of the medial margin of the patella either by compression or by shearing as the patella slides back, pulled by the contracting quadriceps. Meniscal Biomechanics and Attachments of the Knee 5 min. Postoperative MRI shows tendon healing and no visible defects. Open Advanced Search Log in Fracture lines radiate from central point (starburst appearance) commonly caused by a force from collision or fall: Patellar dislocation: Ossification appears . Meniscal Zones 5 min. The superficial medial collateral ligament (MCL) extends from the medial epicondyle to insert not just near the joint but 7 cm below the joint space. This pattern represents dislocation and impaction of the patella against the femur when it is laterally dislocated. The fimbriae of the uterine tube, also known as fimbriae tubae, are small, fingerlike projections at the end of the fallopian tubes, through which, The tympanic membrane is a vital component of the human ear, and is more commonly known as the eardrum. 3, American Journal of Roentgenology, Vol. Radiographic features Plain radiograph MRI of the knee demonstrates characteristic appearance of recent transient dislocation of the patella. Rupturing, or tearing, of the medial patellar ligament can be the cause of this issue. You can use Radiopaedia cases in a variety of ways to help you learn and teach. This modified Schenck anatomic-based classification system is most commonly used in clinical practice and adequately describes most traumatic knee dislocations by accurately describing the injured structures, including the ACL, posterior cruciate ligament (PCL), MCL, lateral collateral ligament (LCL) and posterolateral corner (PLC) [ 6 ]. . mri Axial STIR Coronal STIR Sagittal STIR MRI Axial STIR MRI of the knee demonstrates characteristic appearance of recent transient dislocation of the patella. Once this ligament is torn, it often does not heal properly, and the patella can then dislocate more easily, which is why patella dislocation recurs in some patients with this ligament injury. Although these articles do not have all bibliographic details available yet, they can be cited using the year of online publication and the DOI as follows: Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names, and use of punctuation. Three cases are presented in this article in which computed tomography demonstrated the dislocation. Medial instability results in apprehension by the patient. No marginal fracture is visible. A related to higher probability of reoperation. 21, no. due to repetitive microtrauma to the ACL graft15,20or by debris that is present within the knee joint from the drilling and preparation of the tibial tunnel during ACLR.21The consistency (i.e., soft or hard) of the cyclops lesion may be a factor in whether or not loss of knee joint extension or worsening of clinical symptoms occurs after ACLR22. More specifically, the PCL, The arcuate popliteal ligament is a thick and fibrous band of connective tissue that is connected from above to the femur's lateral condyle, the bony, The patellar ligament is an extension of the quadriceps tendon. This disorder can be disabling to the patient and may require a hospital visit for reduction. 7 The time period between patellar dislocation and MRI was not mentioned, and the mean age of patients was 20 years with a wide . We regard this roentgen finding as pathognomonic evidence of previous lateral dislocation of the patella. Conclusion:Pediatric manifestations of TPD seen on MRI are similar to those in adults. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-12583, Medial collateral ligament injury grading. 3, The American Journal of Sports Medicine, Vol. Signs of anterior cruciate ligament partial tear. We regard this roentgen finding as pathognomonic evidence of previous lateral dislocation of the patella. When your knee is dislocated, the femur and tibia no longer connect at the knee joint. Knee injury and Osteoarthritis Outcome Score (KOOS) for Egyptian people Joint Surg Am. 9, No. Patellar dislocation most commonly results from a twisting motion, with the knee in flexion and the femur rotating internally on a fixed foot (valgus-flexion-external rotation) 1 . Enter your email address below and we will send you the reset instructions. This process produces a predominantly chondral fracture at the margin of the articular surface, which becomes radio-graphically visible only when a sufficient portion of subchondral bone is involved. Use the menu to find downloaded articles. It is usually due to trauma sustained during physical or sports activity. Acute traumatic patellar dislocation is the second most frequent cause of traumatic hemarthrosis of the knee, after anterior cruciate ligament tear, and accounts for 3% of all traumatic knee lesions [1], [2]. Small foci of cartilage injury within the patella and posterior tibial plateau. The patients should be thoroughly examined for associated injuries such as haemarthrosis, torn ligaments and avulsion fractures Course Director Clyde Helms, M.D. It appears to be less common and more difficult to evaluate than the patellar rim fracture. By continuing to browse the site you are agreeing to our use of cookies. We assume that the fracture also occurs in younger children but is not radio-graphically detectable because the articular cartilage is thick and the ossification center proportionally small. In none of the 16 cases was any congenital abnormality of the patella such as hypoplasia demonstrated. Description. Medial dislocation of the patella is a previously unreported entity. TPD is often occult in children. INTRODUCTION: Unloader braces are intended to reduce pain and improve function by unloading the medial compartment of the knee in varus osteoarthritis (OA) patients. Medial dislocation of the patella is a previously unreported entity. Quinn described the MRI findings following acute patellar dislocation as contusion or impaction of the medial patellar facet and lateral femoral condyle, along with injury of the medial retinaculum and/or medial patellofemoral ligament (MPFL) (Quinn, 1993). First Patella dislocation and No significant Vastus Medialis disruption Technique Immobilize for 6 weeks Knee in full extension Non-weight bearing (some guidelines allow weight bearing as tolerated) Foam pad protects Vastus Medialis Lateral support holds Patella medially Maintenance Patella r stability program after rehabilitation Smoking could be an important negative factor in isolated meniscus repair. Transient Patellar Dislocation - MSK Radiology Imaging Findings: Hyperintense marrow edema of the anterolateral femoral condyle consistent with bone contusion. Our website services, content, and products are for informational purposes only. The deep part of the MCL, even when it is normal, you may not be able to see. This site uses cookies. When a patella dislocation occurs, the medial patellofemoral ligament is damaged and allows the kneecap to move out of the groove ( Fig. Complete loss of the meniscus inevitably leads to knee joint degeneration. A fibrous band of tissue, this ligament is both broad and flat in shape. In the case of knee extension, this movement happens by the patella offering leverage that the quadriceps tendons it's attached to can put on the femur. Differential Diagnosis Knee Dislocation Knee spontaneous reduction prior to presentation may be misdiagnosed as Patella subluxation Knee Dislocation may occur with low energy mechanism (esp. The injury mostly occurs due to twisting of knee when knee is in mild flexion (<30) which leads to injury of medial stabilizers and medial aspect of patella strikes against lateral femoral condyle. A "dislocated knee" involves the other two bones that make up the knee joint: the thighbone (femur) and the shinbone (tibia). The medial patellofemoral ligament has intrinsic signal and is disrupted at the anterior patella . 11, Fibula. Apprehension sign occurs when the knee is placed at 30 flexion, and lateral pressure is applied. Laterally subluxated patella, edema at the medial patellofemoral ligament (MPFL) attachment. Unable to process the form. 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