Theoretical estimates of cruciate ligament forces: Effects of tibial surface geometry and ligament orientations

1997 ◽  
Vol 211 (6) ◽  
pp. 425-439 ◽  
Author(s):  
A Imran ◽  
J J O'Connor
Keyword(s):  
Tibial Plateau ◽  
Sagittal Plane ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Mechanical Analysis ◽  
Concave Surface ◽  
Surface Geometry ◽  
Flat Surfaces ◽  
Posterior Tilt ◽  
Anterior Cruciate

A mathematical model of the knee in the sagittal plane was used to analyse the effect of tibial surface geometry and ligament orientations on the estimates of cruciate ligament forces. An elementary mechanical analysis was used to calculate the ligament forces L during a simulated antero-posterior (A-P) laxity test (passive test), and during isometric quadriceps contraction (IQE). Three sets of anatomical parameters (sites of bony attachments and lengths of the ligaments) were used from the literature. Flat, concave and convex shapes were considered for the tibial plateau articulating with a compatible convex femoral condyle. Also, the effects of position and posterior tilt of the tibial plateau were analysed for the concave and flat surfaces. The analysis showed that the ligament forces rose steeply as they approached collinearity with the contact force, C. For a flat tibia, the direction of C remained independent of flexion angle or position of the tibial plateau. For the concave tibia, the direction of C varied with flexion as well as with position of the centre of curvature, O, of the tibial plateau. C had an anterior component synergistic with the posterior cruciate ligament (PCL) when the point of contact, F, was anterior to O. On the other hand, C had a posterior component synergistic with the anterior cruciate ligament (ACL) when F was posterior to O. Also, posterior tilt of the flat or concave surfaces resulted in an increase in the anterior component of C. The effects of the convex tibial surface were opposite to those of the concave surface. During the A-P laxity test, the ligament forces arising from the concave tibia were very sensitive to the A-P position of O and to the posterior tilt of the plateau which allowed C and L to approach collinearity. Proximo-distal movement of O had a relatively insignificant effect on the ligament force. Similarly, compared to the concave surface, the posterior tilt of the flat tibia had a lesser effect on the ligament forces. Compared to the passive test, use of the muscle forces during IQE resulted in larger ligament forces, though the trends in force behaviour over the flexion range remained the same. The analysis emphasizes the importance of correct graft placement during ligament reconstruction, and the need to avoid steep inclination (more than 70° to tibial plateau). Increasing the inclination from 70 to 80° doubles the ligament force. Further, the analysis suggests that, in bicompartmental knee replacement, the efficacy of concave surfaces in replacing cruciate ligament function depends critically on the horizontal placement of the tibial component and its orientation about the mediolateral axis.

scholarly journals Variances of the intraarticular landmarks for anterior cruciate ligament tibial footprint: Tibial eminencies have less variability than lateral meniscus on sagittal magnetic resonance scans

2021 ◽  
Vol 56 (4) ◽  
pp. 198-202
Author(s):  
Kadir Büyükdoğan ◽  
Lercan Aslan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Tibial Plateau ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Single Bundle ◽  
Posterior Border ◽  
Tibial Footprint ◽  
Anterior Cruciate

Objective: The purpose of this study was to analyze the sagittal plane variations of intraarticular landmarks for single bundle anterior cruciate ligament (ACL) reconstruction including lateral meniscus, medial and lateral tibial eminencies. Methods: T2 weighted sagittal magnetic resonance (MR) scans of 80 skeletally mature patients aged between 18 to 60 years and without any sign of ligament and meniscal injuries were viewed. Midpoint of ACL, most posterior aspect of anterior horn of lateral meniscus (LMAH), tip of medial eminence (ME) and lateral eminence (LE) were identified on widest antero-posterior (A-P) distance of tibial plateau according to of Staubli-Rausching method and variances were compared. Results: Mean location of center of tibial footprint of ACL at sagittal plane was found as 38.0±4.2% (range, 29-51%) on A-P distance of tibial plateau. Location of posterior border of LMAH, ME and LE were 38.0±12.4% (range, 21-62%), 52.3±4.2% (range, 41- 60%) and 59.5±4.4% (range, 51- 69%), respectively. Difference between the variances of ACL midpoint and LMAH was large enough to be statistically significant (p=<.001) with a large effect size (f=0.59), however differences between the variances of ACL midpoint and bony landmarks were not significant (ME, p=.65; LE, p=.33). Intra and interobserver agreement for measurement of all parameters were detected as moderate to good. Conclusion: There was no constant relationship between ACL midpoint and posterior border of LMAH on sagittal plane MR images. Difference of variances between ACL midpoint and ME and LE were significantly lower than of variances of LMAH.

scholarly journals Association of Compartmental Bone Bruise Distribution With Concomitant Intra-articular and Extra-articular Injuries in Acute Anterior Cruciate Ligament Tears After Noncontact Sports Trauma

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876762 ◽  
Author(s):  
Palaniswamy Aravindh ◽  
Tianyi Wu ◽  
Chloe Xiaoyun Chan ◽  
Keng Lin Wong ◽  
Lingaraj Krishna
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Lateral Compartment ◽  
Bone Bruise ◽  
Collateral Ligament ◽  
Sports Trauma ◽  
Bone Bruises ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are frequently associated with bone bruises, and their presence may be associated with concomitant intra- and extra-articular injuries. Purpose: To investigate the prevalence and pattern of distribution of bone bruises in patients with acute ACL tears from noncontact sports trauma and their association with specific intra- and extra-articular injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 168 patients underwent magnetic resonance imaging (MRI) within 6 weeks of sustaining an ACL tear. Information regarding their demographics as well as MRI evidence of bone bruise patterns and associated injuries was carefully documented. Univariate and multivariate logistic regression analyses were performed to determine the association between bone bruises and concomitant intra- and extra-articular injuries seen on MRI. Results: Bone bruises were observed in 155 (92.3%) of 168 patients. The prevalence of bone bruises was 83.9%, 78.6%, 56.5%, and 29.8% on the lateral tibial plateau, lateral femoral condyle, medial tibial plateau, and medial femoral condyle, respectively. A total of 110 (65.5%) patients had bone bruises in both the medial and lateral compartments of the knee, 41 (24.4%) had isolated lateral compartment bone bruises, 4 (2.4%) had isolated medial compartment bone bruises, and 13 (7.7%) did not have any bone bruises. None of the demographic factors were significantly associated with the presence or absence of bone bruises. The presence of bone bruises was significantly associated with lateral meniscal injuries ( P = .05). Lateral compartment bone bruises were significantly associated with lateral meniscal injuries ( P = .034), while bone bruises affecting both the lateral and medial compartments were significantly associated with medial collateral ligament (MCL) injuries ( P = .044) and lateral collateral ligament (LCL) injuries ( P = .038) in addition to lateral meniscal injuries ( P = .022). Conclusion: Bone bruises are common in patients with acute ACL tears after noncontact sports injuries. The compartmental distribution of bone bruises is associated with concomitant intra- and extra-articular injuries. Bone bruises involving the lateral compartment of the knee are associated with lateral meniscal injuries, while bone bruises involving both the lateral and medial compartments of the knee are associated with MCL and LCL injuries in addition to lateral meniscal injuries.

scholarly journals Anterior Cruciate Ligament Injury and its Rehabilitation in Nepal

2021 ◽  
Vol 59 (239) ◽  
Author(s):  
Suraj Bhusal ◽  
Ujjwal Dotel ◽  
Shamed Kumar Katila ◽  
Saugat Shrestha
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Tibial Plateau ◽  
Treatment Approach ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Return To Play ◽  
Ligament Injury ◽  
Medial Aspect ◽  
Anterior Cruciate

Anterior cruciate ligament is one of the most common ligaments to get injured especially in athletic population. It is a band of dense connective tissue which arises from the antero-medial aspect of the inter condylar area on the tibial plateau and passes upwards and backwards to attach to the posteromedial aspect of the lateral femoral condyle. There is increasing rate of its reported injuries among athletes in Nepal and surgeons report increased consultations among athletes regarding adequate intervention strategies. Factors like over use, inadequate recovery time, playing surface, fitness incompatibility are involved in the increase of anterior cruciate ligament injury among athletes in Nepal. Treatment approach for anterior cruciate ligament injury is ever evolving with regular studies and innovation, but constant guidance and rehabilitation in an institution-based setting have shown positive feedback in recovery and return to play.

Overlap Between Anterior Cruciate Ligament and Anterolateral Meniscal Root Insertions: A Scanning Electron Microscopy Study

2016 ◽  
Vol 45 (2) ◽  
pp. 362-368 ◽  
Author(s):  
Brett D. Steineman ◽  
Samuel G. Moulton ◽  
Tammy L. Haut Donahue ◽  
Cristián A. Fontboté ◽  
Christopher M. LaPrade ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Iatrogenic Injuries ◽  
Meniscal Root ◽  
Anterior Cruciate ◽  
Scanning Electron

Background: The anterolateral meniscal root (ALMR) has been reported to intricately insert underneath the tibial insertion of the anterior cruciate ligament (ACL). Previous studies have begun to evaluate the relationship between the insertion areas and the risk of iatrogenic injuries; however, the overlap of the insertions has yet to be quantified in the sagittal and coronal planes. Purpose: To investigate the insertions of the human tibial ACL and ALMR using scanning electron microscopy (SEM) and to quantify the overlap of the ALMR insertion in the coronal and sagittal planes. Study Design: Descriptive laboratory study. Methods: Ten cadaveric knees were dissected to isolate the tibial ACL and ALMR insertions. Specimens were prepared and imaged in the coronal and sagittal planes. After imaging, fiber directions were examined to identify the insertions and used to calculate the percentage of the ACL that overlaps with the ALMR instead of inserting into bone. Results: Four-phase insertion fibers of the tibial ACL were identified directly medial to the ALMR insertion as they attached onto the tibial plateau. The mean percentage of ACL fibers overlapping the ALMR insertion instead of inserting into subchondral bone in the coronal and sagittal planes was 41.0% ± 8.9% and 53.9% ± 4.3%, respectively. The percentage of insertion overlap in the sagittal plane was significantly higher than in the coronal plane ( P = .02). Conclusion: This study is the first to quantify the ACL insertion overlap of the ALMR insertion in the coronal and sagittal planes, which supplements previous literature on the insertion area overlap and iatrogenic injuries of the ALMR insertion. Future studies should determine how much damage to the ALMR insertion is acceptable to properly restore ACL function without increasing the risk for tears of the ALMR. Clinical Relevance: Overlap of the insertion areas on the tibial plateau has been previously reported; however, the results of this study demonstrate significant overlap of the insertions superior to the insertion sites on the tibial plateau as well. These findings need to be considered when positioning for tibial tunnel creation in ACL reconstruction to avoid damage to the ALMR insertion.

scholarly journals A Quantifiable Risk Factor for ACL Injury: Applied Mathematics to Model the Posterolateral Tibial Plateau Surface Geometry

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199831
Author(s):  
Jimmy Tat ◽  
Drew Crapser ◽  
Motaz Alaqeel ◽  
Justin Schupbach ◽  
Jacob Lee-Howes ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Tibial Plateau ◽  
Applied Mathematics ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Surface Geometry ◽  
Lateral Tibial Plateau ◽  
Acl Injuries ◽  
Significant Difference

Background: The mechanism for traumatic ruptures of the native anterior cruciate ligament (ACL) is frequently a noncontact injury involving a valgus moment with internal rotation of the tibia. The abnormal rotation and translation of the lateral femoral condyle posteroinferiorly relative to the lateral tibial plateau is thought to be related to the geometry of the tibial plateau. Purpose/Hypothesis: The purpose of the study was to mathematically model the posterior tibial plateau geometry in patients with ACL injuries and compare it with that of matched controls. The hypothesis was that increased convexity and steepness of the posterior aspect of the lateral plateau would subject knees to higher forces, leading to a potentially higher risk of ACL injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We mathematically modeled the posterior curvature of the lateral tibial plateau in 64 patients with ACL injuries and 68 matched controls. Using sagittal magnetic resonance imaging scans of the knee, points on the articular cartilage of the posterolateral tibial plateau were selected and curve-fitted to a power function ( y = a × xn). For coefficient a and coefficient n, both variables modulated the shape of the curve, where a larger magnitude represented an increase in slope steepness. Groups were compared using a Mann-Whitney test and α < .05. Results: There was a significant difference in surface geometry between the patients with ACL injuries and matched controls. The equation coefficients were significantly larger in the patients with ACL injuries: coefficient a (ACL injury, 0.9 vs control, 0.68; P < .0001) and coefficient n (ACL injury, 0.34 vs control, 0.30; P = .07). For coefficient a, there was a 78.9% sensitivity, 77.5% specificity, and odds ratio of 12.6 (95% CI, 5.5-29.0) for ACL injury using a cutoff coefficient a = .78. Conclusion: Patients with ACL injuries had a significantly greater posterolateral plateau slope. The steeper drop off may play a role in higher anterior translation forces, coupled with internal rotation torques on the knee in noncontact injury, which could increase ACL strain and predispose to ACL injury.

scholarly journals Distribution of Bone Contusion Patterns in Acute Noncontact Anterior Cruciate Ligament–Torn Knees

2021 ◽  
Vol 49 (2) ◽  
pp. 404-409
Author(s):  
Sophia Y. Kim-Wang ◽  
Melissa B. Scribani ◽  
Michael B. Whiteside ◽  
Louis E. DeFrate ◽  
Tally E. Lassiter ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Meniscal Tears ◽  
Mri Scans ◽  
Anterior Cruciate ◽  
Operative Notes ◽  
Bone Contusions

Background: Bone contusions are commonly observed on magnetic resonance imaging (MRI) in individuals who have sustained a noncontact anterior cruciate ligament (ACL) injury. Time from injury to image acquisition affects the ability to visualize these bone contusions, as contusions resolve with time. Purpose: To quantify the number of bone contusions and their locations (lateral tibial plateau [LTP], lateral femoral condyle [LFC], medial tibial plateau [MTP], and medial femoral condyle [MFC]) observed on MRI scans of noncontact ACL-injured knees acquired within 6 weeks of injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively reviewed clinic notes, operative notes, and imaging of 136 patients undergoing ACL reconstruction. The following exclusion criteria were applied: MRI scans acquired beyond 6 weeks after injury, contact ACL injury, and previous knee trauma. Fat-suppressed fast spin-echo T2-weighted MRI scans were reviewed by a blinded musculoskeletal radiologist. The number of contusions and their locations (LTP, LFC, MTP, and MFC) were recorded. Results: Contusions were observed in 135 of 136 patients. Eight patients (6%) had 1 contusion, 39 (29%) had 2, 41 (30%) had 3, and 47 (35%) had 4. The most common contusion patterns within each of these groups were 6 (75%) with LTP for 1 contusion, 29 (74%) with LTP/LFC for 2 contusions, 33 (80%) with LTP/LFC/MTP for 3 contusions, and 47 (100%) with LTP/LFC/MTP/MFC for 4 contusions. No sex differences were detected in contusion frequency in the 4 locations ( P > .05). Among the participants, 50 (37%) had medial meniscal tears and 52 (38%) had lateral meniscal tears. Conclusion: The most common contusion patterns observed were 4 locations (LTP/LFC/MTP/MFC) and 3 locations (LTP/LFC/MTP).

Articular Cartilage and Meniscus Predictors of Patient-Reported Outcomes 10 Years After Anterior Cruciate Ligament Reconstruction: A Multicenter Cohort Study

2021 ◽  
pp. 036354652110282
Author(s):  
Robert H. Brophy ◽  
Laura J. Huston ◽  
Isaac Briskin ◽  
Annunziato Amendola ◽  
Charles L. Cox ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Patient Reported Outcomes ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Patient Reported ◽  
Meniscal Surgery ◽  
Anterior Cruciate

Background: Articular cartilage and meniscal damage are commonly encountered and often treated at the time of anterior cruciate ligament reconstruction (ACLR). Our understanding of how these injuries and their treatment relate to outcomes of ACLR is still evolving. Hypothesis/Purpose: The purpose of this study was to assess whether articular cartilage and meniscal variables are predictive of 10-year outcomes after ACLR. We hypothesized that articular cartilage lesions and meniscal tears and treatment would be predictors of the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) (all 5 subscales), and Marx activity level outcomes at 10-year follow-up after ACLR. Study Design: Cohort study (prognosis); Level of evidence, 1. Methods: Between 2002 and 2008, individuals with ACLR were prospectively enrolled and followed longitudinally using the IKDC, KOOS, and Marx activity score completed at entry, 2, 6, and 10 years. A proportional odds logistic regression model was built incorporating variables from patient characteristics, surgical technique, articular cartilage injuries, and meniscal tears and treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx outcomes at 10 years. Results: A total of 3273 patients were enrolled (56% male; median age, 23 years at time of enrollment). Ten-year follow-up was obtained on 79% (2575/3273) of the cohort. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC], 22%; lateral femoral condyle [LFC], 15%; medial tibial plateau [MTP], 4%; lateral tibial plateau [LTP], 11%; patella, 18%; trochlea, 8%) and meniscal pathology (medial, 37%; lateral, 46%). Variables that were predictive of poorer 10-year outcomes included articular cartilage damage in the patellofemoral ( P < .01) and medial ( P < .05) compartments and previous medial meniscal surgery (7% of knees; P < .04). Compared with no meniscal tear, a meniscal injury was not associated with 10-year outcomes. Medial meniscal repair at the time of ACLR was associated with worse 10-year outcomes for 2 of 5 KOOS subscales, while a medial meniscal repair in knees with grade 2 MFC chondrosis was associated with better outcomes on 2 KOOS subscales. Conclusion: Articular cartilage injury in the patellofemoral and medial compartments at the time of ACLR and a history of medial meniscal surgery before ACLR were associated with poorer 10-year ACLR patient-reported outcomes, but meniscal injury present at the time of ACLR was not. There was limited and conflicting association of medial meniscal repair with these outcomes.

scholarly journals Incidence of Displaced Posterolateral Tibial Plateau and Lateral Femoral Condyle Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear

2020 ◽  
Vol 48 (3) ◽  
pp. 545-553 ◽  
Author(s):  
David L. Bernholt ◽  
Nicholas N. DePhillipo ◽  
Matthew D. Crawford ◽  
Zachary S. Aman ◽  
W. Jeffrey Grantham ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Lateral Femoral Condyle ◽  
Lateral Tibial Plateau ◽  
Bone Bruising ◽  
Mri Scans ◽  
Anterior Cruciate

Background: Bone bruising of the posterolateral tibial plateau and the lateral femoral condyle sulcus terminalis has a well-established association with anterior cruciate ligament (ACL) tears. Impaction fractures of the femur and tibia may occur in these locations; however, there is a paucity of literature describing these fractures. Purpose: The primary objective was to quantify the incidence, size, and location of impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with primary ACL tears. The secondary objective was to investigate the association between impaction fractures and concomitant meniscal and ligamentous injuries. Study Design: Case series; Level of evidence 4. Methods: Patients with available magnetic resonance imaging (MRI) scans who were treated for primary ACL tear by a single surgeon were identified. MRI scans were reviewed with denotation of posterolateral tibial and femoral condylar contusions and displaced impaction fractures. Measurements of the lateral tibial plateau were taken in all patients with displaced lateral tibial plateau fractures and in a subset of control patients without tibial plateau fracture present to characterize the size and location of the bony lesion. Associations of impaction fractures with concomitant meniscal or ligamentous injuries were evaluated through use of chi-square testing. Results: There were 825 knees identified with available MRI scans. Lateral tibial plateau bone bruising was present in 634 knees (76.8%), and lateral femoral condyle bone bruising was present in 407 knees (49.3%). Posterolateral tibial plateau impaction fractures were present in 407 knees (49.3%), and lateral femoral condylar impaction fractures were present in 214 knees (25.9%). Patients with posterolateral tibial plateau impaction fractures were older than patients without these fractures (42.6 vs 32.7 years; P < .001), whereas patients with lateral femoral condylar impaction fractures were younger (23.8 vs 32.7 years; P < .001). There were 71 knees (8.6%) with a posterolateral tibial plateau impaction fracture with greater than 10% loss of lateral tibial plateau depth, and this group had an increased incidence of lateral meniscus posterior root tears (22.1% vs 12.0%; P = .02). Conclusion: Posterolateral tibial plateau impaction fractures occurred with a high incidence (49.3%) in patients with primary ACL tears and demonstrated an increased association with lateral meniscus posterior horn root tears as their size increased. Lateral femoral condylar impaction fractures occurred in 25.9% of patients with primary ACL tears and entailed an increased incidence of lateral meniscal tears and medial meniscal ramp lesions.

scholarly journals The position of anterior cuciate ligament in frontal and sagittal plane

2010 ◽  
Vol 57 (1) ◽  
pp. 125-130
Author(s):  
L. Stijak ◽  
G. Santrac-Stijak ◽  
V. Nikolic ◽  
Z. Blagojevic ◽  
M. Malis ◽  
...  
Keyword(s):  
Horizontal Plane ◽  
Sagittal Plane ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Frontal Plane ◽  
Lateral Femoral Condyle ◽  
Lateral Condyle ◽  
Medial Aspect ◽  
Measured Angle ◽  
Anterior Cruciate

INTRODUCTION: Position of the anterior cruciate ligament (ACL) represents one of the anatomical factors which can lead to the rupture of the ligament. AIM: The aim of this study was to overview and compare gender and age differences of the position of the ACL and its relation with the medial aspect of the lateral femoral condyle. METHOD: The measurements were performed on the fifty cadaver knees (32 male and 18 female) aged between 15 - 53 years with intact ACL. We were measuring the angle of the ACL in sagittal and frontal plane and the angle of the medial aspect of the lateral condyle in frontal and horizontal plane. RESULTS: Measurements of the ACL in sagittal plane and measurements of the angle of the medial aspect of the lateral femoral condyle in horizontal plane showed statistically significant variations with the age (p<0.05 and p<0.01, respectively). The angle of the medial aspect of the lateral femoral condyle in frontal plane was statistically significant higher than the same measured angle in the horizontal plane (p<0.01). CONCLUSION: ACL forms narrower angle with medial aspect of the lateral femoral condyle in extension of lower leg than in flexion as a result of smaller angle of the medial aspect of the lateral femoral condyle in frontal compared to horizontal plane.

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