Tenodesis: A tenodesis is a procedure where the damaged tendon is sewn to the normal tendon. The synovial membrane is part of a fluid-filled sheath that surrounds a tendon. The images below show the repair of a longitudinal split tear of the peroneus brevis tendon. (2011) Radiographics : a review publication of the Radiological Society of North America, Inc. 31 (3): 791-810. Biceps Tendon Dislocation and Instability. A third-degree sprain includes injuries of the ATFL, CFL, and PTFL. Color Doppler ultrasound is an important part of the tendon sheath assessment;it can differentiate between synovial thickening which is more suggestive of chronic disease,and turbid tendon sheath fluid collection - more indicative of acute exudative tenosynovitis. The most common injuries are tenosynovitis, tendinosis, tears, and tendon dislocation. WebAn MRI is obtained by his primary care physician and depicted in Figure C. Which of the following is the most appropriate next step in management? T1. Muscle testing evaluation shows decreased peroneal muscle strength. Grade II: The fibrocartilaginous ridge and the SPR is avulsed from the posterior aspect of the fibula. Grade III: Bony avulsion of the posterolateral aspect of the fibula containing the cartilaginous rim and a flake of bone permitting the tendon to slide beneath the periosteum. Based on MRI appearance, PTT dysfunction is categorized into three types. The patient then is asked to dorsiflex and evert the foot forcibly. WebX-rays for peroneal tendinosis usually are normal. 1173185, Safran MR, O'Malley D. Peroneal tendon subluxation in athletes: new exam technique, case reports, and review. Peroneal tendon subluxation is commonly encountered in skiing, but also has been reported in other sports, such as gymnastics, ice skating, and rugby[1][6][7]. This groove is formed by the superior peroneal retinaculum (SPR), the fibula, the posterior talofibular ligament, the calcaneofibular ligament and the posterior-inferior tibiofibular ligament. Treatments may include activity modification, rest, non-steroidal anti-inflammatory drugs, bandage or splint, and/or 2015;2015:458786. A rim rent tear of the rotator cuff, also known as partial articular surface tendon avulsion (PASTA), is a specific subtype of partial-thickness rotator cuff tear that involves the articular surface footprint at the site of tendon attachment into the greater tubercle 2.Such small tears can extend along the tendon fibers, causing tendon Davda K, Malhotra K, ODonnell P, Singh D, Cullen N. Peroneal tendon disorders. The MRI shows a split tear in the peroneus brevis tendon. An MRI or ultrasound imaging scan helps confirm the diagnosis. The Peroneal muscles consist of the Peroneus longus and Peroneus brevis. This finding in the presence of a large joint effusion is most likely due to communication between these two structures, a normal variant. At this time, our patient has declined surgery. Ultrasound. In more severe cases, edema may be seen in the adjacent bone marrow or surrounding soft tissue. Rotator cuff tears can occur at different locations of the tendon, and more than one location can be involved 3-5: tendon insertion (footplate): often degenerative, critical zone: degenerative or trauma-related, myotendinous junction: often trauma-related, infraspinatus muscle most often affected. (D) Axial STIR image in different patient shows tenosynovitis and partial tear of the peroneal tendons (arrowhead) with fluid within the common peroneal tendon sheath (arrow). The person with a peroneal tendon tear does not often present acutely but will present later with persistent lateral ankle pain and swelling along the tendon. There is evidence for using manual therapy, specifically the lateral calcaneal glide: To mobilize the left calcaneus, the patient is in left side lying with the calcaneus hanging over the table. The Journal of Foot & Ankle Surgery. [3]. 1. Peroneus brevis and peroneus longus are contained in the retromalleolar sulcus on the fibula. The ligament is composed of two layers. WebStatic Eversion for Peroneus Brevis Tendon Tear Place the outer part of the foot against a wall or you can place both the feet between the legs of a chair. The Management of Lower Extremity Soft Tissue and Tendon Trauma. W. Grasset, N. Mercier. clinics in orthopedic surgery. I Geert et al,. Non-visualization of the long head of biceps tendon in the bicipital groove with a medially Tenosynovitis is a term describing the inflammation of the synovial membrane surrounding a tendon. The MRI is a better diagnostic tool for looking at soft tissue injuries including ligament and interosseous membrane tears. Treatments are also used to help improve ankle range of motion by progressive resistance and ROM exercises without putting excessive strain on the area[13]. Anterior drawer testing and MRI obtained at initial presentation demonstrated a tear of the anterior talofibular ligament (ATFL). 2010 Nov;44(14):1047-53. The MRI shows a split tear in the peroneus brevis tendon. The anterior drawer test (A) and talar tilt test (B) assess injury to the anterior talofibular ligament. The purpose of this paper is to illustrate the normal anatomy of peripheral The peroneal brevis tendon may appear crescentic at this level, but should not be thinner in the middle than periphery. MRI findings of tear include discontinuity of the fibers, focal edema, and hemorrhage, which may occur at the origin or 12 cm distal to the origin of the plantar fascia (Figure 18-5C).1,7,8. Algorithm for the management and treatment of suspected split peroneal brevis tendon. Sportmedizin und Sporttraumatologie. Tenography may be especially helpful in the chronic setting with suspected stenosis within the tendon sheath. Roster B, Michelier P, Giza E. Peroneal tendon disorders. That is usually the journal article where the information was first stated. 12). The peroneus brevis tendon courses laterally and inserts on the base of the fifth metatarsal. Despite supportive therapy with NSAIDs, physical therapy, and bracing, her symptoms persisted. The presence of a tendon defect filled with fluid is the most direct sign of rotator cuff tear. (level of evidence 3A). Stretching is important to recover full function and enhance the healing process.3,4 Immobilization with braces and casting is a noninvasive option to stabilize the ankle and provide added protection from further injury. The ligamentous groups that support the ankle joint include the lateral complex, the medial complex (deltoid) ligaments, the ankle syndesmosis, and the spring calcaneonavicular ligament complex. (A) Axial T1W image shows normal anterior talofibular (ATFL) (arrow) and posterior talofibular (PTFL) (arrowhead) ligaments. On MRI, ligaments are best evaluated on fluid-sensitive sequences such as T2 and STIR. Roth JA, Taylor WC, Whalen J. Peroneal tendon subluxation: the other lateral ankle injury. Common mechanisms for ligamentous injuries are inversion, eversion, external rotation, and dorsiflexion. Rotator cuff tear. Active and resisted dorsiflexion and eversion are prevented during the early rehabilitation phase to reduce stress on the SPR (approximately 6 to 8 weeks[12]. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Navarro-Ballester A, Patel M, Jones J, et al. MRI findings of acute plantar fasciitis include fusiform thickening of up to 78 mm, intermediate signal on T1W and PD images, and hyperintense signal on T2W images (Figure 18-5B). MRI is also excellent for early detection and evaluation of osseous abnormalities including bone marrow edema.1. (level of evidence 5), MT Pfefer, SR Cooper, NL. When refering to evidence in academic writing, you should always try to reference the primary (original) source. After symptoms resolve, the patient begins a progressive rehabilitation programme along with a gradual increase to full activity[4]. Therefore the peroneus longus tendon remains posterior and inferior to the peroneus brevis until the lateral aspect of the foot. Who gets a high ankle sprain? The anterior (extensor) group from medial to lateral is composed of anterior tibialis tendon (ATT), extensor hallucis longus (EHL), and extensor digitorum longus (EDL), which are associated with the mnemonic Tom, Harry, and (anterior tibial artery and nerve) Dick (Figure 18-1A,E).2. JBJS Am. E.g. Anatomy. Radiographics. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Top Contributors - Rachael Lowe, Tess Mertens, Kim Jackson, Admin, Maarten Cnudde, Patti Cavaleri, Simisola Ajeyalemi, Wanda van Niekerk, Rucha Gadgil, Jess Bell and Pinar Kisacik. Initial supportive therapy is important and may enhance the healing process and avoid chronic ligamentous laxity and surgery. 5. Proper assessment of tendon tears with MRI provides critical information to guide the treatment approach. WebRadiopaedia.org, the wiki-based collaborative Radiology resource Tenosynovitis, tendinosis, or tears of the peroneal brevis tendon occur commonly at the level of the lateral malleolus, due to compression between the peroneal longus tendon and lateral malleolus (Figure 18-3D). Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-21629. Sagittal images are useful for assessing conditions of the Achilles tendon. Adjacent soft tissue and bone marrow edema may be present. Magnetic resonance imaging evaluation. Tendon pathology. (A) Sagittal STIR image shows high Achilles tendon tear with complete disruption and retraction of tendon fibers (arrowhead), with surrounding soft tissue edema. Conservative attempts can also include adhesive strapping with a pad to restrict subluxation, J-shaped pads that anchor in front of the fibula and wrap around laterally and posteriorly to hold the tendons in place and non-weight bearing for 2-6 weeks. MRI. The images below show the repair of a longitudinal split tear of the peroneus brevis tendon. If you suspect a structural problem, I would advise getting a scan. The various components of the deltoid ligament are well visualized on both axial and coronal images. Signal characteristics. The images below show the repair of a longitudinal split tear of the peroneus brevis tendon. With the exception of the motion precautions, rehabilitation can proceed much like that of the chronic ankle sprain. Supportive therapy with ankle bracing and analgesics is the mainstay of therapy, but surgical repair is often required in patients with ongoing symptoms. Diagnosis is best made on axial MR images, where the bicipital groove is seen to be empty, and the tendon can be identified medially. The imaging findings of tendinosis, tenosynovitis, and tears are similar to those seen in other tendons. The posterior group includes the Achilles (Figure 18-1A,B) and plantaris tendons. The tear is usually located at the level of the tip of the fibula. The Peroneal muscles consist of the Peroneus longus and Peroneus brevis. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Dislocation of the long head of biceps tendon is a common pathology that can be seen with the long head of the biceps tendon. Non-Surgical Treatment. 2. Surgical options include debridement, tubularization, or, in severe cases, resection of the damaged tendon and (D) Sagittal STIR image shows normal, low-signal PB (arrowhead) and PL (arrow) tendons. In most cases Physiopedia articles are a secondary source and so should not be used as references. 2004;14(4):270-2. Peroneal tendon dislocation is best seen on axial MRI that shows the tendon seated anteriorly and laterally to distal fibula within a pouch formed by a stripped-off superior peroneal retinaculum. The lateral (peroneal) group includes peroneus brevis (PB) medially and peroneus longus (PL) tendons laterally. Injury to these ligaments is also called a high ankle sprain (Figure 18-4C). The incidence of high ankle sprains has been reported to be as much as 10% of all ankle sprains. Radiographic features Plain radiograph. WebIn human anatomy, a hamstring (/ h m s t r /) is any one of the three posterior thigh muscles in between the hip and the knee (from medial to lateral: semimembranosus, semitendinosus and biceps femoris). However, some patients may still experience instability following surgery.9,13 Common complications of surgery include numbness, hyperesthesia, crepitus, pain, and instability.5,9,13 A Cochrane review of 20 randomized controlled trials involving 2262 patients found insufficient evidence to determine the relative effectiveness of surgery versus conservative therapy for lateral ankle injuries.16 We found no evidence regarding the relative effectiveness of surgery versus conservative therapy for peroneal injuries. A negative on this test does not rule out subluxation injury. peroneus longus. Peroneal brevis tears are usually longitudinal and appear as lentiform, boomerang, or C-shaped tendon, or in more severe cases as two separate peroneus brevis tendons on either side of the peroneus longus tendon. Also seen is FDL (arrowhead). When refering to evidence in academic writing, you should always try to reference the primary (original) source. Tuite M, Turnbull J, Orwin J. Anterior Versus Posterior, and Rim-Rent Rotator Cuff Tears: Prevalence and MR Sensitivity. She was referred for physical therapy but complained of persistent ankle pain and no improvement of her symptoms after physical therapy. Here, the peroneal brevis tendon was flattened and borders both the medial and lateral aspects of the peroneal longus, consistent with a split tendon. In quadrupeds, the hamstring is the single large tendon found behind the knee or WebTears of the peroneus brevis tendon may cause ankle pain, swelling, and instability. 2. Attention should be paid to the overall alignment of the leg and posture of the hindfoot. These changes are best seen near the calcaneal insertion. 3. An MRI also may show a tear. AJR Am J Roentgenol. Signal characteristics. Sensitivity and specificity are 92% and 93%, respectively 4. WebRadiopaedia.org, the wiki-based collaborative Radiology resource The thickness of the tendon is constant on sagittal images, resulting in parallel anterior and posterior margins. Subluxation or dislocation of the peroneal tendons is a disorder involving an elongation, a tear, or an avulsion of the superior peroneal retinaculum[1]. AJR Am J Roentgenol. [3], The primary aim of treatment is to afford pain relief, restore mechanics and return the patient to their desired level of active participation. WebX-rays for peroneal tendinosis usually are normal. In infants and neonates, conservative management of subluxing peroneal tendon is the rule and spontaneous resolution is extremely high[5],[10]. If tenosynovitis persists after a period of rest and infection has been excluded, a steroid injection may provide symptomatic relief. Plantar fascia: This is the longest ligament of the foot that runs from the heel to the toes to form the arch. Peroneal tendinopathy can be difficult to distinguish. Physical examination consists of inspection, palpation for tenderness, swelling, crepitus, ankle and subtalar range of motion, talar tilt, and anterior drawer signs.4,5,13 It is important to compare the injured ankle to the uninjured ankle. General features include. Contributional factors for the development of peroneal tendonitis are tight calf muscles, inappropriate training, poor foot biomechanics such as over-pronation of the foot or excess eversion of the foot, inappropriate footwear and muscle weakness of them. The MRI shows a split tear in the peroneus brevis tendon. WebOBJECT The aim of this study was to enhance the planning and use of microsurgical resection techniques for intrinsic brainstem lesions by better defining anatomical safe entry zones. There is overlap in the imaging features on ultrasound with tendon thickening and contour change present 5. 2020;49(Suppl 1):1-33. There was extensive lateral ankle swelling but no bruising. WebThe peroneus brevis tendon continues directly to its insertion onto the tuberosity (base) of the fifth metatarsal. 2012. 2010. Supportive therapy with ankle bracing and analgesics is the mainstay of therapy, but surgical repair is often required in patients with ongoing symptoms. The peroneus brevis tendon continues directly to its insertion onto the tuberosity (base) of the fifth metatarsal. Non-visualization of the long head of biceps tendon in the bicipital groove with a medially Treatments may include activity modification, rest, non-steroidal anti-inflammatory drugs, bandage or splint, and/or Anatomic classification of lateral ligament tear is based on the number of ligaments involved. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The superficial layer has variable attachments and crosses two joints while the deep layer has talar attachments and Its role is to support the head of the talus. 2012. As strength and proprioception improve, the patient can progress through plyometric and functional activities that lead to a return to competition[12]. (1996) American journal of orthopedics (Belle Mead, N.J.). Matthew Varacallo, Travis J. [2] The pain tends to be of gradual onset which progressively worsens over weeks or months with the continuation of aggravating activities. Peripheral nerve entrapment occurs at specific anatomic locations. Typically, these are normal in acute tears with chronic tears showing degenerative-type changes 1: may show a decreased acromiohumeral interval, <7 mm on true AP shoulder radiographin chronic tears, <2 mm on an 'active abduction' view in acute tears, may show decreased supraspinatus opacity and decreased bulk due to fatty atrophy in chronic tears, humeral subluxation superiorly may be seen in chronic tears, may show features of subacromial impingement, spur formation on the undersurface of acromioclavicular joint, acromion with an inferolateral tilt seen on outlet view (i.e. Conde Melgar MJ et al. J Trauma. The PTFL normally demonstrates an inhomogeneous appearance due to interdigitating fat. 6. In particular, non-operative treatment is indicated for grade I and possibly grade III injuries, depending on the degree of displacement of the cortical fragment[8]. And most of the time, it does not cause any discomfort. If the tenosynovitis is infective, urgent surgical assessment is required. (level of evidence 4), Wukich DK, Tuason DA. In the following images the lateral malleolus has been identified and incision is made just behind this structure. This can be related to Knock Knee. The plantar fascia provides strength for walking and assists with balance. In general, T1-weighted (T1W) images provide good anatomic detail and T2-weighted (T2W) images are useful for assessing the abnormal increase in water that characterizes most pathologic conditions. AJR Am J Roentgenol. An extremity surface coil is used to enhance spatial resolution. The posterior group includes Achilles tendon and plantaris tendon (not shown). Can certainly be related the knock knee. Both peroneal tendons are in a common synovial sheath behind the lateral malleolus, where they are held in place by the superior peroneal retinaculum to prevent subluxation of the ankle. Grade I: The retinaculum, which is confluent with the periosteum on the fibula, is stripped away from the fibula, resulting in dislocation of the tendons. 2005;184 (5): 1490-4. The PTT is normally approximately twice the size of the adjacent FDL tendon. Unable to process the form. Tendon debridement and repair is most effective when less than 50% of the tendon is torn. 2009. Clin Orthop Relat Res. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. The peroneus brevis tendon attaches to the little toe. Tendon pathology can be categorized as tendinosis, tenosynovitis, entrapment, rupture, and dislocation. Plantar fascia: This is the longest ligament of the foot that runs from the heel to the toes to form the arch. MRI. (level of evidence 4), JM Blinkey, PW Stratford, SA Lott, DL Riddle. She was prescribed crutches and an air splint. FHL tendinosis and tensynovitis may be seen as the tendon passes between the hallux sesamoid bones at the head of the first metatarsal bone. MRI can show the static anatomy of the peroneal tendons. The complex of the medial collateral ligaments of the ankle joint is collectively called deltoid ligament.It attaches the medial malleolus to multiple tarsal bones. 2. In most cases Physiopedia articles are a secondary source and so should not be used as references. Manual Therapy. EFORT open reviews. Partial Thickness Rotator Cuff Tears: Current Concepts. Radiographic features Plain radiograph. -. Tendon retraction may also be present, which can be graded using the Patte classification. Calcaneal fractures predispose the peroneal tendons to partial tears, dislocation, or entrapment. W B Saunders Co. (2001) ISBN:0721690270. 2017 Jun;2(6):281-92. Clinics in sports medicine. We searched PubMed and Ovid using the search term split peroneus brevis tendon. (level of evidence 2A), PH Craiget al. The Achilles tendon does not have a synovial sheath, instead is surrounded by a paratenon laterally and posteriorly. Plantar calcaneonavicular: This is a ligament that connects the calcaneus to the talus. Tendinosis, tenosynovitis, and tears occur commonly at or distal to the groove between the posterior tubercles of the talus, or at the decussation with the FDL (knot of Henry). A 64-year-old white woman presented to our family medicine clinic with complaints of right lateral ankle pain with dorsiflexion and inability to bear weight for the past 4 weeks. Care Injured. A combination of anatomical pulse sequences such as spin-echo T1 or fast-spin echo proton density (FSE PD) and fluid-sensitive sequences such as fat-suppressed FSE T2 or short-tau inversion recovery (STIR) is used. Surgical options include debridement, tubularization, or, in severe cases, resection of the damaged tendon and tenodesis. hypointense homogeneous signal; adjacent tendon may be thickened; some Indirect signs on MRI are - subdeltoid bursal effusion, particularly if anterior, medial dislocation of biceps, fluid along biceps tendon and diffuse loss of peribursal fat planes. Palmer W, Bancroft L, Bonar F et al. Surgical procedures to release the tendon rarely have a role. A cause of lateral ankle pain and instability is a split or tear of the peroneus brevis tendon (PBT) or peroneus longus tendon (PLT); however, PBT tears are more common. Full-thickness tearsare easier to diagnose on MRI than partial-thickness tears2. Plain film radiographs do not reveal soft tissue abnormalities; however, they are useful for excluding arthritis, bone abnormalitiessuch as pes cavus, or fractures. Acute ligament injuries can be classified on MRI based on severity of findings. The foot is imaged in the oblique axial plane, oblique coronal plane, and oblique sagittal plane. Who gets a high ankle sprain? Chronic lateral ankle instability and excessive subtalar and ankle varus rotation may cause damage to the peroneal tendons and their associated structures[6]. Treatment will then depend on the severity of the injury. flexor hallucis longus tendon. Patient's with pes cavus feet may be predisposed to peroneal subluxations and lateral ankle instability[7]. Case 3: with medial dislocation of biceps, Case 11: full thickness supraspinatus tear, Case 22: subscapularis tendon tear (preoperative and postoperative ultrasound), Patte classification of rotator cuff tendon retraction. tenosynovitis, tendinosis, tear; variant anatomy: accessory flexor digitorum longus, accessory soleus, peroneocalcaneus internus, tibiocalcaneus internus muscles tarsal tunnel syndrome; Peroneal compartment. An MRI also may show a tear. Marrow edema of the lateral calcaneus and peroneal tubercle may also be noted. Acute injuries should be screened for fracture using the Ottawa Ankle Rules to determine if referral for radiography is indicated for assessment of avulsion injury[7]. Ankle tendons are seen as low-signal intensity structures on all MRI sequences. This injury is far less common than the lateral ankle sprain. (B) Sagittal STIR image in different patient shows increased signal of the proximal plantar fascia at the calcaneal insertion consistent with plantar fasciitis (arrow). There is overlap in the imaging features on ultrasound with tendon thickening and contour change present 5. An MRI or ultrasound imaging scan helps confirm the diagnosis. Can certainly be related the knock knee. And most of the time, it does not cause any discomfort. 1% (14/2045) L 3 An MRI of his ankle is shown in Figure A. Intraoperatively, a tendon defect a is measured to be 4cm in length. The drawer test and talar tilt were not performed because of the pain. WebThe peroneus longus and brevis tendons sublux or dislocate from the lateral retromalleolar groove. If Lisfranc injury is confirmed, a plaster cast with a toe plate extending under the toes is applied below the knee to immobilize the joint. She continued to have pain for about 5 years after her injury; she reported that the pain had resolved until 4 weeks before her office visit, when the pain returned. Imaging the ankle in 20 of plantar flexion decreases the magic angle effect.1, The ankle retinacula are localized thickenings of the superficial aponeurosis that maintain approximation of the tendons to the underlying bone. The peroneus brevis tendon attaches to the little toe. 12 . 5. edema may be seen in the adjacent bone marrow or surrounding soft tissue. 2012. the Department of Family Medicine (BC, PP, TW) and the Department of Orthopedics (ES), Medical College of Georgia, Georgia Regents University, Augusta. The peroneal tendons have an oval shape; however, they may appear flattened at the level of the malleolus. MRI. 7. Moosikasuwan J, Miller T, Burke B. Rotator Cuff Tears: Clinical, Radiographic, and US Findings. 11. The above changes can be seen in asymptomatic individuals but prominent, tendon thickening, loss of fibrillary pattern and neovascularity are more commonly seen in symptomatic patients 4. (D) Axial T1W image shows normal anterior (arrow) and posterior (arrowhead) tibiofibular ligaments. Ultrasound is a very effective way to assess the tendons and can show an abnormal appearance or tear. Examination frequently reveals the painful limitation of subtalar joint range of motion secondary to muscle splinting. 2. Treatment will then depend on the severity of the injury. The Surgical Treatment of Peroneal Tendinopathy (Excluding Subluxations): A Series of 17 Patients.. The history is helpful to differentiate neuropathic, musculoskeletal, and vascular pain. J Trauma. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Plantar calcaneonavicular: This is a ligament that connects the calcaneus to the talus. De Quervain tenosynovitis, also known as washerwoman's sprain/strain, is a painful stenosing tenosynovitis involving the first extensor (dorsal) tendon compartment of the wrist (typically at the radial styloid). This results from a tear, avulsion or significant laxity of the SPR. Treatments. Acute full-thickness tendon tears demonstrate complete discontinuity of the tendon, with tendon retraction and surrounding soft tissue edema (Figure 18-3A). 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