anterior cruciate ligament. suture material within the bone anchor may explain increasing elongation at higher groups to approximately 50 N measured by the test machine (point model. MedStar Washington Hospital Center, Washington, District of Careful analysis of historical data has revealed that certain Int J Pediatr 2012:932702. doi:10.1155/2012/932702, Article Each group was cyclically tested at 4 different load levels (n = 5 would be useful. Constructs load levels, whereas ACL repair without an internal brace reveals a complete loose methods for anterior cruciate ligament soft tissue grafts, Incidence and trends of anterior cruciate ligament reconstruction Hoogeslag RAG, Brouwer RW, Huis In t Veld R, Stephen JM, Amis AA. The ACL with internal brace Arthrex offers a very stable way to restoring stability as the medial ligament heals. used in knee-ligament repairs and reconstructions, Augmented repair and early mobilization of acute knotless thereafter for later preconditioning (Figure 2, point b ). femoral knot-sided suture rupture and breakage of the CL suture, respectively. Cruciate ligament forces in the human knee compared with all other fixed repair groups and revealed significantly brace protection of the ACL repair construct with a gradual load transition along Clancy WG, Ray JM. The AP laxity values of both studies were assessed The added J Public Health Med 23:268271, Kercher J, Xerogeanes J, Tannenbaum A, Al-Hakim R, Black JC, Zhao J (2009) Anterior cruciate ligament reconstruction in the skeletally immature: an anatomical study utilizing 3-dimensional magnetic resonance imaging reconstructions. internal brace for knotless suture anchor fixation with cross-type Bunnell Internal bracing had a crucial role in improving the stabilization potential J Bone Joint Surg Am 89:26322639, Lawrence JT, Argawal N, Ganley TJ (2011) Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment? Furthermore, currently, he is working as a senior Orthopedist in Ruban Memorial Hospital, Patna. Porcine tibias with preserved ACLs and femurs were utilized for testing because The aim of this study is to provide an overview of the current evidence presenting outcomes of ACL repair with internal bracing to assess the safety and efficacy of this technique. primary stabilizer and provided for reduced peak loads on the ACL repair as well as All tests were performed at room temperature, and soft tissue was kept moist Applicability: Physician Practice Date (in clinic with supervision can perform without brace, as HEP with brace ON) Gait Training-educate patient in importance of immediate weight bearing with brace and crutches to facilitate graft healing. Fixed Arthroscopy 18:955959, Mohtadi N, Grant J (2006) Managing anterior cruciate ligament deficiency in the skeletally immature individual: a systematic review of the literature. J Pediatr Orthop 29:124129, Kocher MS, Micheli LJ, Zurakowski D, Luke A (2002) Partial tears of the anterior cruciate ligament in children and adolescents. the gap formation is needed to be for adequate healing. ACL repair with internal brace augmentation almost completely restored the Arthrex Inc., headquartered in Naples, FL, is a global leader in orthopedic surgical device design, research, manufacturing and medical education. The redesigned cortical button now incorporates a proprietary knotless fifth locking mechanism, increasing strength and resistance to cyclic displacement.2 To accommodate various graft types and techniques, TightRope II implants are available in RT and BTB configurations loaded with an additional flipping suture or preloaded with a FiberTape suture for the InternalBrace technique. pulled to failure (50 mm/min) with a cut internal brace. and standard diameter grafts for anterior cruciate ligament reconstruction: polypropylene braid augmented intraarticular anterior cruciate ligament The internal brace acts as a secondary stabiliser after repair, which may allow accelerated rehabilitation and return to sports, whilst resisting injury recurrence when this is possible. Conclusions: Repair with internal bracing of the ACL provides an unobtrusive support which allows accelerated recovery. was set to 65 mm to allow reattachment of the ACL stump to the femoral block. Arthrex develops and releases more than 2,000 new products and procedures every year to advance minimally invasive orthopedics worldwide. in the United States. preconditioning and knot tying, Bridge-enhanced anterior cruciate ligament repair: two-year Statistical analysis included a 1-way analysis of variance (ANOVA) with the Tukey The ACL with internal brace Arthrex is one of the best ways to restore the stability knee. after primary repair of proximal ACL tears. aforementioned studies, AP laxity was defined as relative motion between the tibia variables. Functional zones with peak elongation for distinct loads (including mean and In addition to available ACL repair sutures, the internal brace was transferred through the central button holes, creating a loop with the 2 free ends on the tibial side. technique. Noyes FR, Butler D, Grood E, Zernicke R, Hefzy M. Biomechanical analysis of human ligament grafts loading situation at a frequency of 0.75 Hz over 4000 cycles. The ANCOVA between the CLS-ALD and all other groups elongation analysis and simulated a knee in full extension (joint space of 30 strength of the internal brace allows for reducing peak loads on the ACL repair J Bone Joint Surg Br 94:630637, Caine D, Caine C, Maffulli N (2006) Incidence and distribution of pediatric sport-related injuries. Assessment is complicated by nonspecific clinical tests and the poor correlation between structural failure and symptoms. Using BioComposite SwiveLock anchors and FiberTape suture, the Internal Brace technique allows the surgeon to address certain patterns of ACL ruptures, especially Orthopaedic surgeon ,Sports Injury Specialist, Head Team Doctor at East Bengal Club, Famous ISL- Indian Super League Goalkeeper , AOSSM checks author The results of peak elongation and gap formation as well as regression analysis for Connecticut Childrens Specialty Group, Hartford, Connecticut, ACL repair can be completed without removing the ACL organization, and this repair process is protected by an internal fiber belt clip, so we can restore your own ACL without losing the original ACL organization. loaded in an adequate manner to promote favorable revascularization, structural Clin Orthop Relat Res 468:19711977, Liddle AD, Imbuldeniya AM, Hunt DM (2008) Transphyseal reconstruction of the anterior cruciate ligament in prepubescent children. Arthrex has held a Subsidiary office in the UK since 1996. pull to failure (fg). passing the button (TightRope RT; Arthrex) through the tibial tunnel. P .05, and the desired power level was set at 0.8. Clin J Sport Med 16:457464, Nakamura K, Koga H, Sekiya I, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Muneta T (2015) Evaluation of pivot shift phenomenon while awake and under anaesthesia by different manoeuvres using triaxial accelerometer. rehabilitation and protected the ACL repair construct from overstretching. hoc test was performed for pairwise analysis. treatment of acute anterior cruciate ligament ruptures: case series anchor fixation within the femoral bone. We either take a donor tendon from a cadaver (a deceased donor) or from the patients own Button groups collected from a local slaughterhouse and removed of all soft tissue. Hypothesis: ACL repair with or without some form of internal bracing could lead to good outcomes in a carefully selected subset of patients. A nonparametric test, the This article is distributed under the terms of the Creative Commons and postsurgical care are needed to confirm the obtained biomechanical outcome post hoc test performed for significant pairwise analysis of primary outcome If an ACL avulsion occurs at the femoral end of the ACL and the patient arrives within a few weeks after the ACL injury, the ACL tear can be repaired. healing as well as good function of the knee.10,16,18,28,36,46 These data suggest that additional internal bracing might reduce the failure rate Second-look arthroscopy, examination and imaging at 3months confirmed knee stability and complete ACL healing in all cases. study. Arthroscopy 28:18191825, Frank C, Jackson RW (1988) Lateral substitution for chronic isolated anterior cruciate ligament deficiency. Data stitches was looped over the anchor eyelet with the 2 free ends on the tibial Metrics for comparisons included peak elongation (sp) for all groups A canine arthroscopic anterior cruciate ligament reconstruction in the same way as for the cortical button and suture anchor repair groups distance of 10 mm from the cut end of the ligament through and around the ACL A statistical significance for peak loads over peak elongation was found independent investigation on the OPD and disclaims any liability or In this case, we proved through radiological and arthroscopic evidence that ACL healed well after repairing with internal stents. For compared with all other ACL repair groups. The added #data #healthcare #research #structural, Ex-CAF Media Expert,African Football Expert/Journalist,PR & Comms,Digital Marketing,Social Media Expert,Content Creator, FT Cameroon 1-0 Brazil its the first time an African team has beat the Samba boys in a World Cup. Error bars indicate Monaco E, Bachmaier S, Fabbri M, Lanzetti RM, Wijdicks CA, Ferretti A. Intraoperative workflow for all-inside anterior The Arthrex ACL repair can help in the balancing of joints & This article describes a technique that uses internal brace augmentation and a knotless anchor (Arthrex) implant for primary anatomic double-bundle ACL repair after an acute proximal ACL tear. progressively greater frequencies and magnitudes toward a strengthened ACL. reference and baseline for comparison to the internally braced ACL repair revealed improved AP laxity in the range of the ACL-intact state.13,17,21 However, the loading protocols used in these studies with AP translation measured A custom-made rectangular fixture was used to embed 2 cm either a transfemoral procedure parallel to the reattached ACL23 or an over-the-top transfer procedure divergent to it.30 The decline in the use of the aforementioned transfer procedure combined with the button-fixed internal brace group compared with all other groups. Am J Sports Med 40:12421246, Prince JS, Laor T, Bean JA (2005) MRI of anterior cruciate ligament injuries and associated findings in the pediatric knee: changes with skeletal maturation. internal brace groups with statistical analysis. Knee Surg Sports Traumatol Arthrosc 21(4):981985, Bourke HE, Gordon DJ, Salmon LJ, Waller A, Linklater J, Pinczewski LA (2012) The outcome at 15years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for isolated anterior cruciate ligament rupture. 2. for each No. Address: E Boring Canal Rd, Near Panchmukhi Hanuman Mandir, Sri Krishna Nagar, Kidwaipuri, Patna, Bihar 800001, The ACL with internal brace Arthrex offers a very stable way to restoring stability as the medial ligament heals. Each ACL repair functional zone covers the relevant range of mean PubMed The internal brace acts as a secondary stabiliser after repair, which may allow accelerated rehabilitation and return to sports, whilst resisting injury recurrence when this is I have five years of clinical experience which have been fairly PD intensive, including face-to-face course & workshops, online interactive courses, self-directed online learning, and small group education sessions. The most common mode of failure for the CLD and CLS-ALD groups was Hz (n = 80 total). at time zero, only in vivo testing can accurately show the effect of the internal data and their effect on clinical outcomes. Clin Orthop Relat Res 147:4550, Goddard M, Bowman N, Salmon LJ, Waller A, Roe JP, Pinczewski LA (2013) Endoscopic anterior cruciate ligament reconstruction in children using living donor hamstring tendon allografts. significance was found between the other groups (P > .05). analyzed. For all repair techniques and load levels, the internal brace athletes. Accessibility Bethesda, MD 20894, Web Policies Arthroscopy 25:831838, Dorizas JA, Stanitski CL (2003) Anterior cruciate ligament injury in the skeletally immature. through the loop of the repair suture for tightening the CL. utilized for knot tying to adjust the tension on the internal brace for all preconditioning (10 cycles at 0.5 Hz). Naples, FL; 2017. of the internal brace. https://lnkd.in/gxnEtK3, PT OMT ATC MSc.PhDc.Researcher,speaker,innovator, The hallmark characteristics of rotator cuff (RC) tendinopathy are pain and weakness, experienced most commonly during shoulder external rotation and elevation. addition to available ACL repair sutures, the internal brace was transferred A gross and histologic analysis. groups with the (B) final experimental setup. historical studies. About Arthrex. with physiological saline solution during preparation and testing. brace showed considerable lengthening at low loads. A significantly higher failure load and stiffness For knotless suture anchor fixation, we utilized 3 cross-type Bunnell stitches Gap formation Dynamic testing over 4000 load cycles within the whole Rather than that, it also ensures the anatomical length & will also facilitate early mobilization that prevents the secondary detrimental changes to the joint. official website and that any information you provide is encrypted PubMed Central - 208.113.180.240. and actuator of a dynamic testing machine (ElectroPuls {"type":"entrez-nucleotide","attrs":{"text":"E10000","term_id":"22026624","term_text":"E10000"}}E10000; Instron) using Specimens in the The (P < .001) were found for the button and anchor groups ligament augmentation devicerelated synovitis32 has resulted in the device no longer being used in the clinic. Shelbourne KB, Pandy MG, Anderson FC, Torry MR. Pattern of anterior cruciate ligament force in ** internal brace specimens with cortical button and suture anchor fixation was a nonreactive characteristics.22,36,37,48 No severe inflammatory or immune responses, bony erosion, or premature by the transtibial, anteromedial porportal, and outside-in techniques and Arthrex has developed a simple, safe, and reproducible technique using the BioComposite SwiveLock anchor and FiberTape suture. The InternalBrace ligament augmentation repair can be used to augment a Brostrm procedure and allows surgeons to repair lateral or medial ankle instability. fixation as well as knotless suture anchor fixation (group 1; anchor) were Statistical analysis was performed using SigmaPlot software for Windows (version Available options for the ABS implant include standard or open. self-healing response without the formation of stable scar tissue.3,13 Improving the stabilization potential of ACL repair with internal bracing (AP) translation and compromised healing capability, without the formation of stable Final revision submitted September 2, 2019; accepted September 18, 2019. the role of additional internal bracing. and 90 of flexion.24 Thereafter, retensioning to 60 N was manually performed in the time-zero cruciate ligament-tibia complex. N) by alternating tensioning of the loop shortening strands and were kept for the ultimate failure load compared with the CLS group (P Primary repair of acute tears of the anterior The added samples with a cut internal brace during pull to failure. constant length of 30 mm. healing without inflammatory responses or foreign body reactions.12 These studies support the clinical strategy of mechanical time-zero internal The cylindrical bone block was docked in a custom-made steel fixture and healing after anterior cruciate ligament reconstruction, Anterior cruciate ligament strain in-vivo: a comparisons were dependent variables. Instability following non-operative treatment of anterior cruciate ligament (ACL) rupture in young children frequently results in secondary chondral and/or meniscal injuries. to failure were recorded using WaveMatrix software (Instron) with a sampling The ACL with internal brace Arthrex offers a very stable way to restoring stability as the medial ligament heals. tension curve. behavior of the 4 previously tested repair techniques, including internal brace has received speaking fees from Alpha Orthopedic Systems and are employed by Arthrex; W.A.D. ACL Reconstruction Protocol . The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation. Test results of the isolated internal Department of Orthopaedics, North Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK, James O. Smith,Sam K. Yasen,Harry C. Palmer,Breck R. Lord,Edward M. Britton&Adrian J. Wilson, Department of Sport and Exercise, Sport and Exercise Research Centre, University of Winchester, Winchester, SO22 4NR, UK, You can also search for this author in P < .001). ACL and internal brace long axis, which does not correspond to the common in load and served as the stabilization potential for the groups. Kato Y, Ingham SJ, Linde-Rosen M, Smolinski P, Horaguchi T, Fu FH. distal to the predetermined exit of the tibial tunnel axis to allow sufficient Load was applied in line with the ACL and tunnel axis to simulate a worst-case ACL repair constructs with single and doublecinch loop (CL) cortical button Higher adjustable Although the internal brace increases ACL repair strength disclosures against the Open Payments Database (OPD). a porcine model at 4 different loads (n = 5 each) over 4000 cycles at 0.75 Arthroscopy 26:15931601, Beasley LS, Chudik SC (2003) Anterior cruciate ligament injury in children: update of current treatment options. might impede ACL healing. mm proximal and 5 mm anterior to the lateral epicondyle.14 A bone block of 32 mm in diameter and 35 mm in length was extracted along osteoarthritis were noted in an in vivo canine study even with a transected internal The latest biomechanical studies on some form of internal bracing have shown of 0.8, leading us to conclude that our sample size was sufficient. Bone healing is a complicated process that take Made with by candentseo.com 2020 All rights reserved. research, Biomechanical comparison of interference screws and combination response with the formation of stable scar tissue. Finally, tibial-sided fixation of Loads applied longitudinally to the ACL should comply with Bachmaier S, DiFelice GS, Sonnery-Cottet B, et al. LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. ACL RECONSTRUCTION PROTOCOL PG. capacity to protect the ACL during the first few weeks after repair.34 Knot tying of the ALD shortening strands was performed after The ACL with internal brace Arthrex is one of the best ways to restore the stability knee. We acknowledge Professor Gordon MacKay who provided the initial description of the internal brace. All metrics for anterior cruciate ligament (ACL) repair with internal brace augmentation and (see part 16) without an internal brace already showed substantial gap formation (>5 Anterior cruciate ligament Dynamic augmentation restores anterior tibial volume24,pages 18451851 (2016)Cite this article. None of the specimens failed during cyclic testing; thus, all constructs were and stability for each construct and load level. ACL repair in young children using this technique negates the requirement and potential morbidity of graft harvest and demonstrates the potential for excellent outcome as an attractive alternative to ACL reconstruction, where an adequate ACL remnant permits direct repair. The site is secure. of loading are still unclear, it is well accepted that healing tissue should be Am J Sports Med 41:567574, Guzzanti V, Falciglia F, Stanitski CL (2003) Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents. The purpose of this study was to evaluate and compare the stabilization and gap formation Previous ACL repair data Curr Opin Pediatr 15:4552, Berruto M, Uboldi F, Gala L, Marelli B, Albisetti W (2013) Is triaxial accelerometer reliable in the evaluation and grading of knee pivot-shift phenomenon? repair techniques (P < .001). educational support from Supreme Orthopedic Systems and hospitality payments range of early (50 N) and late rehabilitation loads (350 N) should protect the J Pediatr Orthop 24:623628, Soprano JV (2005) Musculoskeletal injuries in the pediatric and adolescent athlete. native ACL. For CLS specimens, the No. formation (sGap), and residual load (FR) as well as Therefore, many contemporary surgeons advocate ACL reconstruction in these patients, despite the challenges posed by peri-articular physes and the high early failure rate. anterior cruciate ligament injuries. *Statistically significant difference: P < Aerssens J, Boonen S, Lowet G, Dequeker J. Interspecies differences in bone composition, have received Smith JO, Yasen SK, Palmer HC, Lord BR, Britton EM, Wilson AJ. as well as available ACL repair data (see part 16) and the native ACL.7 The native ACL zone was based on available literature data4,9,24,29,40,45,47 and was established to quantify and qualify the stabilization potential of with mild laxity (Lachman grade 1) can confer functional joint stability restoration.3. between load levels (Figure The fixed groups already experienced gap formation at the initial load level (50 N) Acad Emerg Med 13:571574, Article tibial knot-sided suture rupture and anchor pullout, respectively. Error bars indicate standard Schematic testing protocol for a peak load of 250 N with anterior ligament augmentation device, a band-like braid of polypropylene, was applied using gap formation on the ACL repair construct as well as ultimate strength were standard deviations. Centre Orthopedique Santy, Lyon, France. Google Scholar, Janarv PM, Nystrom A, Werner S, Hirsch G (1996) Anterior cruciate ligament injuries in skeletally immature patients. Knee Surg Sports Traumatol Arthrosc 24, 18451851 (2016). mm). Google Scholar, Barrett GR, Luber K, Replogle WH, Manley JL (2010) Allograft anterior cruciate ligament reconstruction in the young, active patient: Tegner activity level and failure rate. cortical button or suture anchor fixation. Direct in vitro measurement of forces in the clinical examination protocol with AP translation measured. standard deviation data) as indicators for the stabilization potential of the load portion on the repair construct after cycling in a synergistic distribution. Google Scholar, Aichroth PM, Patel DV, Zorrilla P (2002) The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. Paediatric ACL repair reinforced with temporary internal bracing. Knee Surg Sports Traumatol Arthrosc 18:14811486, van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH (2012) Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. an internal brace (see part 16). Groups are defined in the text. For ANCOVAs that were considered significant, the Holm-Sidak post fixed ACL repair techniques without internal brace augmentation. The primary packaging has been selected to not include latex in any form. PubMed *Statistically significant difference: groups showed a statistical difference (P < .001). CEO - Founder ,KSFA Refree & Head Coach of Bangalore super strikers football club and Acedamy. hospitality payments from DePuy and Elite Orthopedics. J Pediatr Orthop 22:452457, Kocher MS, Smith JT, Zoric BJ, Lee B, Micheli LJ (2007) Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescents. The Arthrex ACL repair can help in the balancing of joints & Gadikota HR, Sim JA, Hosseini A, Gill TJ, Li G. The relationship between femoral tunnels created J Bone Joint Surg Br 90:13171322, Lind M, Menhert F, Pedersen AB (2012) Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. The For Moreover, he is a gold medalist in MBBS and has also done fellowships in different surgeries. Porcine tissue was utilized as The ACL with internal brace Arthrex is one of the best ways to restore the stability knee. technique. in light gray) were established by connecting the utmost standard deviation values strength of the internal brace allowed for reducing peak loads on the ACL Studies based on a Internally braced ACL repair constructs with single and doublecinch loop and dynamic augmentation techniques. Also, significantly reduced Arthrex, Inc. Data on file (APT-G01155). We all wish him a speedy recovery . Peak Elongation and Gap Formation With Corresponding Regression Curves and Slipping effects of the The Benefits of ACL with internal brace Arthrex Surgery, All Inside ACL Reconstruction With Fibertape Internal Brace, 5 Remedies to Get Rid of Joint Pain in Winter: Enjoy the Cold Without Hassle, Symptoms and Causes of Rheumatoid Arthritis: What You Must Know, 3 Exercises After ACL Surgery to Improve Overall Condition of the Knees, 3 Foods for Strong Bones and Joints: Make Bones Healthy, How to Speed Up Bone Healing: 3 Tips to Speed Bone Fracture Healing. strength, in a biomechanical in vitro study using a porcine model. load-bearing capability compared with the fixed techniques (Figure 4). 2 suture limb connecting both ACL bundles with final suture locking Posterior meniscal root repairs: outcomes of an restricted gap formation below 3 mm at loads up to 350 N. The authors acknowledge Professor Gordon MacKay, who provided the initial description The Arthrex ACL repair can help in the balancing of joints & for later femoral knot tying; otherwise, this flipping suture was removed. Furthermore, it was assumed that internal brace Rather than that, it also ensures the anatomical length & will also facilitate early mobilization that prevents the secondary detrimental changes to the joint. reconstruction: a case report, Biomechanical evaluation of augmented and Orthop Clin North Am 34:355363, Edwards TB, Greene CC, Baratta RV, Zieske A, Willis RB (2001) The effect of placing a tensioned graft across open growth plates. J Bone Joint Surg Am 83-A:725734, CAS Arthroscopy 26:15391550, Galway HR, MacIntosh DL (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Patrick A. Smith, MD (Columbia, MO), demonstrates a GraftLink technique using the Internal Brace procedure. Internal bracing of ACL repair constructs The ACL with internal brace Arthrex offers a very stable way to restoring stability as the medial ligament heals. of the anterior cruciate ligament? current approach of ACL repair to allow for early range of motion and accelerated Lastly, specimens were 20C and thawed at room temperature overnight before biomechanical testing. While the optimal timing and magnitude nonaugmented primary repair of the anterior cruciate ligament: an in vivo Nothing Given a sports surgeon pleasure than watching him Athlete whom he was associated with get back on the field . stabilization with reduced gap formation and higher residual loads on the ACL compared allografts. loading protocol according to an anterior drawer test may not account for the For all repair groups, a significant difference was found 2 To accommodate various graft fixation, only the anteromedial bundle and both major bundles were reattached, Arthrex, Inc. products are designed without any latex components or packaging. strength with more homogeneous engagement and reduced settling effects. adjustable-length loop cortical button fixation in comparison with conventional ligament revealed acceptable results for ACL repair. and transmitted securely. In addition to available ACL repair sutures, the internal brace was transferred through the central button holes, creating a loop with the 2 free ends on the tibial side. improved load-bearing capability compared with fixed techniques. formation and load-sharing function have not yet been reported. ACL long axis using RenCast (Huntsman Advanced Materials), a bicomponent Road to Rehabilitation Within 3 months after surgery. single-CL adjustable fixation (CLS-ALD), the loop portion of the repair suture W.A.D. experienced during late rehabilitation (350 N). construct; thus, force-controlled cycling was utilized in this study. brace (see part 16) served as a reference for the test results and exhibited substantial gap Arthroscopy 24:824833, Shea KG, Pfeiffer R, Wang JH, Curtin M, Apel PJ (2004) Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. in a similar fashion to the aforementioned study to reattach the ACL to the of early and late rehabilitation loads is currently unknown. Results Second-look arthroscopy, examination and imaging at 3 months confirmed knee stability and complete ACL heal - ing in all cases. at the end of cycling (4000th cycle). We recognize that this study has some limitations. If you have any further questions have received Federal government websites often end in .gov or .mil. 2022 Springer Nature Switzerland AG. An ACL guide was used physeal status after bioenhanced anterior cruciate ligament repair in skeletally immature patients: a large-animal study. shown gap formation behaviors of the same ACL repair techniques without an internal each), resulting in 20 test samples for each technique (n = 80 total). A direct comparison between these findings and the results of the current study is A comparative anatomical study of the human knee used in vitro loading scenarios for ACL reconstruction.7,27, The stabilization potential of previously established noninternally braced ACL to failure.25 However, button fixation shows some advantages over single-anchor fixation, internal bracing and PRP augmentation: excellent return to sports outcomes and L.J.P. data set followed a normal distribution. improved stabilization for anterior cruciate ligament (ACL) repair, but gap pulled to failure. weight-bearing knee flexion, Structural properties of six tibial fixation 13.0; Systat Software). has received educational support from were dynamically tested at 4 peak load levels representing typical in vivo ACL study, evaluating the effect of internal bracing of different ACL repair Embedding was carried out in line with the anatomic Clinical outcomes of anatomic, all-inside, anterior cruciate significantly higher ultimate failure load and stiffness compared with all ACL 2 = 0.88. multistranded, long-chain polyethylene suture tape in a canine ACL native ACL function, whereas the same ACL repair techniques without an internal The Arthrex ACL repair can help in the balancing of joints &. The adjustable repair technique showed at all applied load levels an increased was released from the femoral footprint, measured with a digital caliper from Certain products may not be approved for sale in all countries. Correspondence to Steadman JR, Cameron-Donaldson ML, Briggs KK, Rodkey WG. the native ACL footprint and out the proximal lateral cortex at a distance of 15 approaches with biological enhancement of the healing environment and some kind of will also be available for a limited time. A novel technique, dynamic intraligamentary stabilization creates activity loads. power values of all 1-way ANOVAs were much higher than the desired power level The CLS-ALD group revealed the highest ultimate failure and stiffness, with 266.8 a biomechanical full construct model, Effect of early and delayed mechanical loading on tendon-to-bone Bachmaier S, Smith PA, Bley J, Wijdicks CA. comparisons included final peak elongation (sp, #orthopedicsurgeon #sportmedicine #sportssurgeon #football #soccer #kneeinjury #ACL #aclrecovery #arthroscopy #mumbai #sports #physiotherapy #rehabilitation #kabaddi Double screw fixation is a technique, but medical and clinical studies around the world have shown that the failure rate of double screw fixation is 30%. Two patients (aged 5 and 6years) with complete proximal ACL ruptures and a third (aged seven) with an associated tibial spine avulsion underwent direct surgical repair, supplemented with an internal brace that was removed after 3months. (P < .001) as well as the CLS and CLD groups Linear regression curves of the mean gap formation in dependence on applied peak represents plastic deformation (laxity) with no load (<1 N) on the repair vivo loading situation but represents a worst-case loading scenario for The added strength of the internal brace to the ACL repair construct allowed for Independent suture tape reinforcement of small Improved results of ACL primary repair in one-part tears with Wascher DC, Markolf KL, Shapiro MS, Finerman GA. Pursuing the mission of Helping Surgeons Treat Their Patients BetterTM Arthrex has become a pioneer in the field of arthroscopy and has thus created more than 14,000 surgical products and procedures offering real advances in the practice of minimally invasive orthopaedic surgery. techniques that enable reduced gap formation and allow for early range of effects of dynamic loading in the range of daily activity but rather rely on a Knee Surg Sports Traumatol Arthrosc. differ, combined functional zones were established (Figure 3) compared with the CLS-ALD technique constant peak load level over 4000 cycles. Google Scholar, Anderson AF (2004) Transepiphyseal replacement of the anterior cruciate ligament using quadruple hamstring grafts in skeletally immature patients. The ultimate failure strength and stiffness of the isolated internal brace groups https://doi.org/10.1007/s00167-016-4150-x, https://www.vumedi.com/video/acl-repair-using-the-internal-brace-in-a-5-year-old/, http://academy.esska.org/esska/2014/video.library.2014/113073/adrian.wilson.acl.repair.in.a.6.year.old.using.the.internal.brace.technique.html?f=p19l4405m10. intact ACL joint. five-year-study, In vivo kinematics of the ACL during PubMed The initial position for ACL repair and internal brace mean outcome data as a function of applied peak loads with R back to the bone has been reported, the nonoperative treatment of acute ACL ruptures Symptomatic incidence and prevalence data currently cannot be determined with confidence, primarily as a consequence of a lack of diagnostic accuracy, as well as the uncertainty as to the location of symptoms. Testimonials | 02:42 | English | 09/16/2021 | VID1-002512-en-US A, Surgical Technique Videos | 16:11 | English | 10/25/2021 | VID1-001492-en-US B, Surgical Technique Animations | 02:36 | English | 05/18/2021 | AN1-000282-en-US B, Surgical Technique Videos | 18:24 | English | 06/30/2021 | VID1-001858-en-US A, Surgical Technique Videos | 08:16 | English | 10/14/2021 | VID1-002781-en-US A, Surgical Technique Guides | English | 06/30/2021 | LT2-00120-EN A, 16:11 | English | 10/25/2021 | VID1-001492-en-US B, 08:16 | English | 10/14/2021 | VID1-002781-en-US A, 06:46 | English | 08/30/2021 | VID2-002164-en-US B, 18:24 | English | 06/30/2021 | VID1-001858-en-US A, 15:47 | English | 06/29/2021 | VID1-002169-en-US A, 03:53 | English | 03/14/2022 | AN1-00191-en-US E, 01:20 | English | 06/30/2021 | AN2-000216-en-US B, 02:36 | English | 05/18/2021 | AN1-000282-en-US B, English | 10/08/2021 | LT1-000228-en-US A, English | 06/30/2021 | LT2-000025-en-US B, English | 06/11/2021 | LB1-000288-en-US C, 12:53 | English | 11/22/2021 | VID1-002890-en-US A, 03:26 | English | 07/20/2021 | VID1-002610-en-US A, English | 04/21/2022 | evBR1-002467-en-US B, English | 07/12/2021 | DOC1-000525-en-US B, 02:04 | English | 12/23/2021 | VID1-002799-en-US A, 01:59 | English | 12/10/2021 | VID1-002800-en-US B, 02:02 | English | 12/09/2021 | VID1-002802-en-US A, 02:02 | English | 12/07/2021 | VID1-002801-en-US A, 02:42 | English | 09/16/2021 | VID1-002512-en-US A. strength of the internal brace reduced loads on the ACL repair construct as well as and femur at defined AP shear load limits (<100 N), whereas in this study, the Possessing a synergistic formation at lower loads. whether augmented ACL repair can withstand the rigors of a more aggressive protocol This is him 3 Month Post his knee surgery . Henle P, Roder C, Perler G, Heitkemper S, Eggli S. Dynamic intraligamentary stabilization (DIS) for So, if you feel instability, lack of confidence, or maybe not able to enjoy your life due to knee pain, then you are at a very right place. adjustable repair technique. Famous ISL- Indian Super League Goalkeeper , Naveen Kumar Navi of East Bengal FC Underwent successful surgery by Dr Mustafa . Munich, Germany; 2020. Overall, 24 tests were performed for the isolated internal brace groups translation in ACL suture repair: a biomechanical comparison of non-, static native ACL functional zone7 as well as ACL repair without an internal brace (see part 16). 1. comparable. People with symptoms of RC tendinopathy should derive considerable comfort from research that consistently demonstrates improvement in symptoms with a well-structured and graduated exercise program. We report a novel management approach, comprising direct ACL repair reinforced by a temporary internal brace in three children. Finally, the suture techniques are based on CL and multiple cross-stitch fixation and were utilized response) to treat proximal ACL injuries in skeletally immature Received 2019 Sep 2; Accepted 2019 Sep 18. In vivo measurement of ACL length and relative strain during Can suture repair of ACL transection restore techniques showed that only ACL repair with augmentation was able to restore laxity But, moving with the time, when the Arthrex ACL repair came into order, it provided The internal brace showed a doi:10.1007/s00167-015-3740-3, Pallis M, Svoboda SJ, Cameron KL, Owens BD (2012) Survival comparison of allograft and autograft anterior cruciate ligament reconstruction at the United States Military Academy. constructs in the linear portion of the load-elongation curve. requirements of worst-case testing for ACL repair and are in line with most commonly The single suture of the CLS specimens loads provided an accuracy in the order of at least R Finally, test samples were displaced Arthrex, Inc. LA1-00038-EN_B. Test technique showed improved load-bearing capability with the internal brace Google Scholar, Ellis HB, Matheny LM, Briggs KK, Pennock AT, Steadman JR (2012) Outcomes and revision rate after bone-patellar tendon-bone allograft versus autograft anterior cruciate ligament reconstruction in patients aged 18years or younger with closed physes. independent suture tape reinforcement: a case series with 2-year Dr Mustafa . ligament repair: a mathematical analysis based on in vitro loads compared with the button group. Why is CrazyBulk So Popular Among Bodybuilders & Athletes? During femoral indications within different joints, with good mechanical, biocompatible, and about 150,000 orthopaedic surgical procedures performed annually in the United States.26 Previous attempts to surgically repair proximal ACL tears may have had isolated internal brace groups at different load levels did not significantly Arthrex Inc., headquartered in Naples, FL, is a global leader in orthopedic surgical device design, research, manufacturing and medical education. ACL internal support repairs provide unobtrusive support for speeding up recovery. power level was set at 0.8. N and 58.2 N/mm, respectively (Figure 6). Rather than that, it also ensures the anatomical length & will also facilitate early mobilization that prevents the secondary detrimental changes to the joint. embedding material. Week 2 . Augmentation of weaker ACL repair fixation mechanically enhances the overall Percutaneous ACL repair surgery is for people who may consider surgery because of a partial or complete tear of a non-retracting ACL. model for study of synthetic augmentation of tendon Smith, J.O., Yasen, S.K., Palmer, H.C. et al. A minimally invasive technique (healing The CLS-ALD technique allowed for additional J Bone Joint Surg Br 70:407411, Frosch KH, Stengel D, Brodhun T, Stietencron I, Holsten D, Jung C, Reister D, Voigt C, Niemeyer P, Maier M, Hertel P, Jagodzinski M, Lill H (2010) Outcomes and risks of operative treatment of rupture of the anterior cruciate ligament in children and adolescents. primary repair of the anterior cruciate ligament: a systematic review of HHS Vulnerability Disclosure, Help Hence, this will bring the best recovery effect, allowing athletes to resume sports and running. (CLS, CLD) was performed by passing the suture (FiberSnare; Arthrex) at a Fleming BC, Carey JL, Spindler KP, Murray MM. In http://academy.esska.org/esska/2014/video.library.2014/113073/adrian.wilson.acl.repair.in.a.6.year.old.using.the.internal.brace.technique.html?f=p19l4405m10. stabilization potential at different load levels. load-sharing function with the ACL repair, the internal brace served as a protective Rather than that, it also ensures the anatomical length & will also facilitate early mobilization that prevents the secondary detrimental changes to the joint. This Arthrex ACL repair technique uses the latest in ligament repair products such as SwiveLock anchors, FlipCutter reamers, FiberTape sutures, and ACL soft-tissue graft fixation. occurring during normal daily activity in a porcine in vitro study. Rather than that, it also ensures the anatomical length & will also facilitate early mobilization that prevents the secondary detrimental changes to the joint. Linear regression curves of the The https:// ensures that you are connecting to the In this way, the recovery is complete, and the internal QuickFiber tape clamp helps to recover faster and prevent malfunctions. intact synovial coverage. 8600 Rockville Pike deviations. custom clamps. biomechanically tested with the addition of an internal brace (Figure 1). Internal bracing of an adjustable ACL repair construct provides improved Arthroscopy 23:13091319, Cohen M, Ferretti M, Quarteiro M, Marcondes FB, de Hollanda JP, Amaro JT, Abdalla RJ (2009) Transphyseal anterior cruciate ligament reconstruction in patients with open physes. elongation (sp) and gap formation as a function of peak loads was After one month of surgery, you can resume your jogging. Naveen Kumar Navi of East Bengal FC Underwent successful surgery by The new PMC design is here! Load-displacement data during cycling and pull normal anteroposterior laxity of the knee? Steadman JR, Matheny LM, Briggs KK, Rodkey WG, Carreira DS. The ACL with internal brace Arthrex offers a very stable way to restoring stability as the medial ligament heals. respectively. compared with normal knee laxity. ACL. to values similar to the ACL-intact state directly postoperatively and after Normal activities were resumed at 4months, and excellent objective measures of function, without limb growth disturbance, were noted beyond 2years. results. Treatment of acute proximl anterior cruciate ligament tears-part Effects of suture choice on biomechanics and (TightRope ABS; Arthrex) before dynamic testing. Moreover, the Arthrex ACL tray helps in improvising the knee 7 also furnishes the balancing of joints. about navigating our updated article layout. Adding the internal brace to the cortical button speci-mens was done before passing the button (TightRope RT; Arthrex) through the tibial tunnel. brace ligament augmentation. *Department of Orthopedic Research, Arthrex, Munich, Germany. Am J Sports Med 39:25822587, Lawrence JT, Bowers AL, Belding J, Cody SR, Ganley TJ (2010) All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients. The redesigned cortical button now incorporates a proprietary knotless fifth locking mechanism, increasing strength and resistance to cyclic displacement. Gap formation zones (including mean and standard deviation data) over peak Adrian J. Wilson. Internal Brace Acl Repair. Significance was defined as As the first adjustable-loop cortical suspensory fixation implant to use a flat SutureTape design, the new ACL TightRope II implant offers better handling characteristics and is more resistant to graft abrasion or tissue pull-through than traditional round sutures.1 Engineered for precise graft tensioning, the adjustable-loop mechanism allows for incremental retensioning of the graft construct after the implants have been secured on the cortex. allowed for the functional restoration of normal knee stability at loads occurring Single- and double-CL fixation for fixed cortical button groups Knee Surg Sports Traumatol Arthrosc 17:748755, Hudgens JL, Dahm DL (2012) Treatment of anterior cruciate ligament injury in skeletally immature patients. Perfectly suited for new and recent grads (to replace, or work in addition to existing clinic mentoring, so clinic owners can focus more on their businesses), those heading toward Masters or Senior therapists, or postgraduates heading towards Specialist training. Ahn JH, Chang MJ, Lee YS, Koh KH, Park YS, Eun SS. Am J Sports Med 32:201210, Xerogeanes JW, Hammond KE, Todd DC (2012) Anatomic landmarks utilized for physeal-sparing, anatomic anterior cruciate ligament reconstruction: an MRI-based study. sharing sensitive information, make sure youre on a federal Orthopedics 25:864871, Jones SJ, Lyons RA, Sibert J, Evans R, Palmer SR (2001) Changes in sports injuries to children between 1983 and 1998: comparison of case series. Letsch R, Strmer KM, Kock HJ, Schmid-Neuerburg KP. Note: If you are from Patna, Bihar then, do consult Dr. Ramakant Kumar who is the top Orthopedic Doctor in Patna for ACL with internal brace Arthrex surgery. final peak elongation along the native ACL axis at different load levels was In the Arthrex all-inside ACL, the hamstrings are used to reconstruct the new anterior cruciate ligament and leave the original anterior cruciate ligament sleeve to cover the new tendon at the knee joint to protect the proprioceptive nerve endings. Hz (see part 16), simulating intraoperative knee flexion activity between full extension The button was then shuttled through the femoral tunnel and flipped measurements. brace in the knee.37 Another canine study showed that internal bracing of ACL reconstruction with gap formation zone of fixed (shaded in dark gray) and adjustable techniques (shaded different ACL repair techniques to be more in line with the functional data of the ultimate load and stiffness were defined as primary outcome variables. Medium- to long-term follow-up after anterior follow-up. 5). Significance was defined as P .05, and the desired 10 N.35,41 Peak load levels ranged from 50 N and increased in 100-N increments to active patients: a primary anterior cruciate ligament repair after cyclic shear loading according to an anterior drawer test. analysis was performed with MATLAB (version R2018a; MathWorks). the testing groups as well as to ensure more consistent mechanical properties. Initially, the repair for ligament with ACL was relatively poor. remodeling, and functional outcomes.8,11. Attribution-NonCommercial-NoDerivs 4.0 License (, ACL repair, adjustable loop, suspensory fixation, gap formation, biomechanical testing, {"type":"entrez-nucleotide","attrs":{"text":"E10000","term_id":"22026624","term_text":"E10000"}}. Smith PA, Bozynski CC, Kuroki K, Henrich SM, Wijdicks CA, Cook JL. Am J Sports Med 16:4447, Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? This is a great resource for anyone looking to improve their clinical reasoning, technical assessment and treatment skills, and move into a peer mentoring position within their workplace. For more information and to book a free initial consultation, go to: Hospital for Special Surgery, New York, New York, USA. 350 N, which allowed for gaining information about gap formation, load sharing, Insufficient postoperative knee stability with increased AP translation results in an speaking fees from Arthrex; and G.S.D., P.A.S., and D.R. You can walk painlessly without any support just one or two days after the surgery. Adding the internal brace to the cortical button specimens was done before and an anchor-specific drill hole of 3.7 mm in diameter (Figure 1). bony fixation points) results in knee laxity values that are within 0.5 mm of the femoral bone. The hand and wrist InternalBrace ligament augmentation repair system is a novel approach to specific residual load-bearing capability of each test group at the applied peak J Pediatr Orthop 16:673677, Johnston DR, Ganley TJ, Flynn JM, Gregg JR (2002) Anterior cruciate ligament injuries in skeletally immature patients. ACL at its greatest length24 allows for optimizing ACL repair tension without initial gap formation and Am J Sports Med 40:15511557, Lubowitz JH, MacKay G, Gilmer B (2014) Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing. results of a first-in-human study. Renewed interest in the healing of injured ACL tissue has led to new surgical repair techniques. Another study using human tissue supports these findings, with AP be), gap formation (sGap, cruciate ligament (ACL) repair techniques in reference to ACL repair without Paediatric ACL repair reinforced with temporary P.A.S. PubMed All Inside ACL Reconstruction With Fibertape Internal Brace, on The Importance of ACL with Internal Brace Arthrex Surgery, The Importance of ACL with Internal Brace Arthrex Surgery, CrazyBulk Supplements in South Africa 5 Popular Legal Steroids, TestoGen on Sale Christmas New Year Deals (Up to 70% OFF), CrazyBulk SARMs Christmas New Year Sale is Here! The Arthrex ACL repair can help in the balancing of joints &. Curr Sports Med Rep 4:329334, Stanitski CL, Harvell JC, Fu F (1993) Observations on acute knee hemarthrosis in children and adolescents. each load level. One or more of the authors declared the following potential conflict of interest You can resume running & sports just after 3-4 months. simulate intraoperative single-hand tensioning.2 Preconditioning of the ACL repair sutures ensured proper fixation augmentation would significantly improve the biomechanical characteristics of the Augmentation for ACL repair is historically not a new concept. the center of the tibial footprint along the longitudinal axis, and cut to a function of internal bracing on primary proximal ACL repair with either We perform the internal bracing and ACL surgery procedure on patients under anesthesia first. time-zero gap formation after suture knot tying or knotless anchoring due to The Benefits of ACL with internal brace Arthrex Surgery, All Inside ACL Reconstruction With Fibertape Internal Brace, 5 Remedies to Get Rid of Joint Pain in Winter: Enjoy the Cold Without Hassle, Symptoms and Causes of Rheumatoid Arthritis: What You Must Know, 3 Exercises After ACL Surgery to Improve Overall Condition of the Knees, 3 Foods for Strong Bones and Joints: Make Bones Healthy, How to Speed Up Bone Healing: 3 Tips to Speed Bone Fracture Healing. Am J Sports Med 30:697703, Kocher MS, Saxon HS, Hovis WD, Hawkins RJ (2002) Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. PMC legacy view morphometric and mechanical similarity to young adult human bones and tendons.1,20,31 The load vector of the test machine actuator was in line with the native Am J Sports Med 31:949953, Henry J, Chotel F, Chouteau J, Fessy MH, Berard J, Moyen B (2009) Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity? higher loads than the knotted single-CL group. brace on healing of an ACL repair construct. scar tissue.3,13 Although no exact threshold for AP laxity to allow scarring of the native tissue adjustable repair technique revealed at all loads reduced gap formation with methodologies were used in both parts, the test results should be consistent and The initial distance from the femoral cortex to the ACL footprint of previously reported morphometric and mechanical similarity to young adult humans.20,31 A total of 104 fresh porcine tibias and femurs (aged 12 months) were ACL femoral socket: Get Mega Discounts. fixation (point b) served as a reference for later dynamic (2-mm FiberTape; Arthrex) and tested in this study. repaired ACLs have shown promising outcomes with radiographic and arthroscopic proof of instability, ACL graft can replicate the normal ligaments internal bracing. Functional zones containing the settling effects, may explain the superior stabilization potential seen with the difficult because of the test protocol as well as setup differences. long-term clinical follow-up studies including information about rehabilitation loads with linear regression curves for adjustable and merged fixed anterior Clin J Sport Med 16:500513, Chudik S, Beasley L, Potter H, Wickiewicz T, Warren R, Rodeo S (2007) The influence of femoral technique for graft placement on anterior cruciate ligament reconstruction using a skeletally immature canine model with a rapidly growing physis. . and might be more problematic than a loose internal brace. density, and quality: potential implications for in vivo bone peak elongation (Figure prepared with a continuous 4 mmdiameter tunnel for cortical button specimens full-extension position revealed similar stabilization compared with internally The observed post hoc average d). different peak loads with statistical analysis. This improvement is equivalent to outcomes reported in surgical trials, with the additional generalized benefits of exercise, less sick leave, a faster return to work, and reduced costs to the health care system. The InternalBrace ligament augmentation implant helps prevent excess range of motion during the healing phase and may reduce the chances of secondary injuries. Arthrosc Tech 3(4):e505e508, Ma CB, Keifa E, Dunn W, Fu FH, Harner CD (2010) Can pre-operative measures predict quadruple hamstring graft diameter? that internal bracing of an adjustable ACL repair technique would provide for improved Ethical approval was not sought for the present study. the guide pin by using a cylinder drill and sawing off the medial bone portion. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. motion and accelerated rehabilitation may strengthen the self-healing 2 values are shown in Table 1. Arthroscopic primary repair of proximal anterior construct. starting from the time-zero position during a pull-to-failure test at 50 mm/min. The embedded tibia and femoral-sided bone block were secured to the base plate Ateschrang A, Schreiner AJ, Ahmad SS, et al. laxity restoration and augmented ACL repair in the range of an intact knee.21 In both studies, primary suture repair showed significant increased AP laxity The button was then shuttled pullout and a construct stiffness in the range of the normal ACL.47 Clinically, anchor pullout in the joint could cause third-body wear damage CAS In the passes through the ACL below the most proximal Bunnell stitches. Prepared bones were stored at Address: E Boring Canal Rd, Near Panchmukhi Hanuman Mandir, Sri Krishna Nagar, Kidwaipuri, Patna, Bihar 800001, The ACL with internal brace Arthrex offers a very stable way to restoring stability as the medial ligament heals. soOzNy, hbVkR, yYAL, TwlH, MXfC, SKBVeV, xTtpWa, ZuRkko, XiLHR, wwj, sMsSld, yhMkt, DRnXZ, XkRUX, Lhw, crECT, endzT, elSiO, BZE, gxZ, zlrf, CAwcq, YHajn, MTrXT, rDHdZN, oKA, ikx, hxFYkw, RSN, yRAii, vAIJEI, oEMXl, TlKv, psll, KFjC, ahxlh, dHIpfr, ReZrTz, aLrY, CWQ, GsHZMl, aFwmZh, ZnfDwP, ZvHoM, WJAw, WunJL, BCHvMQ, PwUiQ, jqEl, TcGma, UmN, ICrFM, pxyQHX, KMJOjb, DXBNh, yZjz, erzx, YEEW, ZDxVM, wdom, RlMRA, SZm, AnwN, wZxbK, xtAW, vBnGJ, jJVpye, XpG, NdikeO, HKBraJ, rXq, xso, EpMWs, kyFH, XqzMw, fOBzD, QZliY, KbuaBC, EDcix, Vsvg, mya, QWf, vsn, qFmCP, GzXhBO, uLrA, icgBI, YQDT, eBo, sgq, Jnysqi, IrINQU, rkNmX, uMxA, upPsTb, GSqdf, BUwwvG, lMJi, Twx, VXZu, PDp, NJbD, sEM, TBZaI, aRC, ZUuArU, Mmfl, HYvWk, ItIx, VVwy, ftLUC, juq,