Arthrosc Sports Med Rehabil. The site is secure. J Hand Surg Glob Online. Plus, we offer tips on how to live healthfully and make the most of your doctors visits. eCollection 2020 Jul. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. "Two other indications where this has been successful are in repairing the dorsoradial ligament at the thumbs carpometacarpal (CMC) joint and the wrists scapholunate ligament," says Shin. PMC . The Event 2013. Suture Tape Augmentation Increases the Time-Zero Stiffness and Strength of Anterior Cruciate Ligament Grafts: A Cadaveric Study. eCollection 2022 May. MeSH Patel NA, Lin CC, Itami Y, McGarry MH, Shin SS, Lee TQ. Baylor Medicine - Hand Surgery . Thumb UCL Repair With InternalBrace Ligament Augmentation Thumb UCL Repair With InternalBrace Ligament Augmentation Resource Type: Surgical Technique Animations Revision Date: 10/29/2021 Duration: 01:52 Reference Number: AN1-00264-en-US | Version: C Related Pages Hand and Wrist DX SwiveLockSL Anchor Thumb Collateral Ligament Reconstruction FOIA Thumb Ulnar Collateral Ligament Repair Augmented with an Internal Brace 2,854 views October 31, 2017 25 09:48 The Event 2015 Collateral Ligament Injuries in The Thumb Digits FEATURING Noah Weiss 3,186 views March 8, 2016 11 05:41 The Event 2013 Treatment Options for Thumb UCL Injuries FEATURING Melvin Rosenwasser 2,058 views February 4, 2014 4 A 3.2-mm drill bit is then used to make a hole at the ulnar aspect of the metacarpal head, just proximal to the attachment of the proximal UCL. Internal/Brace Internal/Brace technology Tcnica de Aumento de Ligamento. Right after the surgery, the elbow is secured in a brace at a 60- to 90-degree angle. UCL repair with an internal brace is indicated for the fast recovery of UCL injuries in athletes. Not only does it repair the ligament, but it also adds extra structural support with a collagen coated fiber-tape that acts as an internal brace. eCollection 2021 Dec. Medicine (Baltimore). ULNAR COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION RADIAL COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION THUMB MP JOINT WITH INTERNAL BRACE A. J. Mencias, M.D. 2020 Apr;39(2):443-455. doi: 10.1016/j.csm.2019.12.003. 2018 Sep;43(9):868.e1-868.e6. Epub 2020 Oct 10. Study with Quizlet and memorize flashcards containing terms like When using a 3.5 mm DX SwiveLock SL anchor in the metacarpal head for reconstruction of the thumb UCL using SutureTape and a palmaris longus autograft what size drill should be used? By Wayne Weil 11 Videos. Scapholunate and lunotriquetral interosseous ligament augmentation with internal bracing in perilunate dislocation: Case reports. We describe the surgical technique of suture tape augmentation for thumb UCL repair. Cedars-Sinai Staff. The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a. Suture Tape Augmentation of the ThumbUlnar Collateral Ligament Repair: A Biomechanical Study. This allows for a . "The internal brace helps prevent stress on the thumb right at the point where the ligament could tear again. Thumb UCL repair with suture tape augmentation demonstrates short-term outcomes comparable to what has been reported for other methods of repair. With the thumb MCP joint held in at least 30 degrees of flexion, the tape-loaded 3.5-mm SwiveLock anchor is inserted into metacarpal head. Sign in Thumb UCL Repair. Please enable it to take advantage of the complete set of features! Research has shown the internal brace approach to be up to five times stronger than traditional repair at time zero, allowing patients to begin therapy earlier in recovery and return to play at their previous level in half the time. Bethesda, MD 20894, Web Policies Clinical results of the BoneWeldingFiji anchor for the treatment of Stener lesions of the thumb. Would you like email updates of new search results? 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Unable to load your collection due to an error, Unable to load your delegates due to an error. Reinforcement of the repair is then carried out with fine absorbable suture to surrounding capsular tissue. Federal government websites often end in .gov or .mil. sharing sensitive information, make sure youre on a federal Bull Hosp Jt Dis (2013). The Orthopaedic and Fracture Clinic Initiate AAROM. Results: Average post-operative thumb metacarpophalangeal (MCP) and interphalangeal (IP) joint range-of-motion (ROM) was 0-57.5 and 0-71, respectively, for chronic tears and 2.2-53.9 and 0-71, respectively, for acute tears. Traditional custom-fitted thumb spica orthosis In a recent cadaver study by Gil et. 2022 Jun 28;4(4):e1253-e1259. UCL repair with an internal brace is indicated for the fast recovery of UCL injuries in athletes. Treatment Options for Thumb UCL Injuries Feat. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation. "But the internal brace essentially replaces the pins.". Splint: A hand-based thumb spica splint with IP free (for thumb) or Safe Position Splint (for other digits) with medial or lateral stops on the opposite site of the repaired ligament is constructed to be worn between exercises and at night. He and the team will follow patients who have received this type of surgery for five years or more to determine ultimate success. Repair of the Thumb Ulnar Collateral Ligament With Suture Tape Augmentation. 2017 Dec;21(4):164-166. doi: 10.1097/BTH.0000000000000173. The .gov means its official. The goal is to Login to view comments. During the critical time of ligament healing, the UCL repair can be enhanced with synthetic material to obviate the need for prolonged postoperative immobilization. The injuryoften called skiers thumb can impact a persons strength and range of motion in the hand, including the ability to grip and pinch. J Hand Surg Am. Kastenberger T, Kaiser P, Schmidle G, Stock K, Benedikt S, Arora R. Arch Orthop Trauma Surg. Thumb UCL Internal Brace Feat. 2022 Cedars-Sinai. By Rothman Hand Surgery FEATURING Asif Ilyas. Both tails of the 1.3-mm SutureTape is then brought proximally over the ligament and loaded into a 3.5-mm SwiveLock anchor. Preparing for the Surgery Your doctor will assess the symptoms and take a medical history. When it comes to scapholunate ligament reconstruction, Shin points out that while there is not yet a perfect answer, internal brace augmentation seems to be the strongest method developed to date. This design severely limits functional use of the thumb. These tears often occur as a result of a radially directed force on an extended thumb. "I think using an internal brace is slowly becoming the gold standard for repairing these ligament tears," says Shin. 4 0 obj Bethesda, MD 20894, Web Policies doi: 10.1016/j.asmr.2022.02.008. The anti edema management will continue for several weeks. At the ulnar aspect of the thumb MCP joint, a longitudinal midaxial incision is made. "This technique has really changed how injuries like these are treated in adolescents and above," says Shin. J Hand Surg Glob Online. Unable to load your collection due to an error, Unable to load your delegates due to an error. Scapholunate Ligament Injury Lesin del ligamento escafolunar Thumb Ulnar Collateral Ligament Injury Repair Reparacin de la lesin del ligamento colateral cubital del pulgar . A 2.5-mm PushLock anchor loaded with 1.3-mm SutureTape and 3-0 FiberWire suture, is placed into a hole at the volar-ulnar base of the proximal phalanx after preparation with a 1.8-mm drill bit. % A tear in the thumbs ulnar collateral ligament (UCL) is a common yet devastating injury for professional and recreational athletes alike. Would you like email updates of new search results? 2021 May 4;10(6):516-522. doi: 10.1055/s-0041-1728805. Gamekeepers thumb; Internal brace; Suture tape; UCL. Tech Hand Up Extrem Surg. FOIA The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation. We offer a novel surgical technique that enhances primary repair of the thumb UCL through appended biomechanical support. R. Kadiyala, J. Sonnenfeld 05:41. The site is secure. J Hand Surg Am. Bull Hosp Jt Dis (2013). Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. What might my incision look like after surgery? Thumb UCL Internal Brace Feat. Since establishing equally impressive outcomes repairing thumb UCL tears, he has begun applying this technique to other hand and wrist injuries as well. Careers. Thumb Ulnar Collateral Ligament Repair with Internal Brace Augmentation - YouTube 0:00 / 5:11 Sign in to confirm your age This video may be inappropriate for some users. What's New in Orthopedics 129K subscribers The animation demonstrates thumb UCL repair with the InternalBrace ligament augmentation construct. R. Kadiyala, J. Sonnenfeld 05:41. HHS Vulnerability Disclosure, Help Background: The purpose of this study is to describe our technique of thumb ulnar collateral ligament (UCL) repair with suture tape augmentation and to evaluate the short-term outcomes in our initial series of patients treated with this method of repair. October 31, 2017. Bookshelf The patient began strengthening exercises at this time, along with the ability to participate in all position-specific drills. The 3-0 FiberWire is used for direct repair of the ligament. To date, no literature exists on the use of suture tape augmentation for repair of the thumb UCL in a competitive athlete cohort. Surgical Technique: Thumb UCL Repair With InternalBrace Ligament Augmentation Procedure. 2019 Mar;77(1):11-20. Steven S. Shin, MD, (Los Angeles, CA) discusses a recent case where he incorporates the 3.5 mm DX SwiveLock SL construct to repair the UCL ligament of the t. It may potentially allow for an expedited recovery and rehabilitation process. October 13, 2022 Internal Brace Augmentation for Gamekeeper's Injury. We present a representative case of a professional basketball player treated with this novel procedure. Clipboard, Search History, and several other advanced features are temporarily unavailable. An official website of the United States government. stream It may potentially allow for an expedited recovery and rehabilitation process. UCL repair with internal brace (Tommy John-Lite) This new type of UCL surgery is groundbreaking that was developed by one of Dr. Scillia's fellowship mentors Dr. Jeffrey Dugas. "This added layer of protection means patients can move their thumb again within about a weeksometimes in as little as two or three days.". A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Methods: Patients with minimum one-year follow up after isolated UCL repair with suture tape augmentation were contacted for clinical evaluation, radiographs, and postoperative outcome questionnaires, including the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and study-specific questions. Epub 2019 Nov 11. Clipboard, Search History, and several other advanced features are temporarily unavailable. One of the most commonly injured structures of the thumb metacarpophalangeal (MCP) joint is the ulnar collateral ligament (UCL). Postoperative appearance is patient specific and dependent on the surgical procedure. January 13, 2021 0 Comments . Subsequently, the adductor pollicis aponeurosis and extensor mechanism are identified, incised, and retracted. Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries. The Event 2013. Before The 3-0 FiberWire is used for direct repair of the ligament. The length of each phase varies depending on each patient and depends on tissue healing and progression. "I expect its popularity will continue to grow.". The .gov means its official. All patients demonstrated stability with a firm endpoint, relative to the unaffected thumb. Accessibility Kinematics of Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation. Dugas performs an Internal Brace ligament augmentation repair by forming a bone socket in the sublime tubercle with a special drill, guide, and tap, and then places a 3.5 mm PEEK SwiveLock anchor loaded with collagen-coated FiberTape suture and a #0 FiberWire suture repair stitch. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Thumb Ulnar Collateral Ligament Repair with Suture Anchor Fixation Feat. Thumb UCL Internal Brace. 2021 Sep;141(9):1499-1507. doi: 10.1007/s00402-020-03625-x. Disclaimer, National Library of Medicine M. Rosenwasser 44:12. HHS Vulnerability Disclosure, Help Rotate the image below to see potential postoperative appearance. Physical examination of your elbow will be performed. We present a novel technique to augment the repair of the UCL with suture tape to provide immediate biomechanical support and strength during the critical time of ligament healing. Dr. Allen Thumb UCL Reconstruction Rehabilitation Protocol Phase I: Immediate Post-Op (Weeks 0-2)-Leave thumb spica splint in place until first visit (bag on arm to shower) . doi: 10.1097/MD.0000000000026827. This site needs JavaScript to work properly. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. !V!B;nkGL#_cz5asG) 0<>;Qm4P]3@41oJ5i~o;sJvQv9f r4A-C -Z]>T]Fo << /Length 5 0 R /Filter /FlateDecode >> A 501(c)(3) non-profit organization, Changing the Game With Internal Brace Augmentation, Translation is unavailable for Internet Explorer. Epub 2018 Mar 16. (1) See image 2. The rehabilitation protocol after a Ulnar Collateral Ligament Repair with Internal Brace surgery typically involves several phases. &Dam[L1-J" iiBUq[{0R 3xVoEouUja,Jd> k '! The Stener Lesion and Complete Ulnar Collateral Ligament Injuries of the Thumb A Review. K`d:V0!QGXCor&J;#Z?='lH3cy?_pOk0qWR_heBU] u)dh5Q :e16&\H11}8 1AE Qf>`?SLXSu {q?u,:g@l2;1FhCSTV9}WKH}[agS~?P3{47*c:lg3l#`vLx}{*_Q]}O)D5*wX[PB{A8k1GtM{@onC 0Ggtz=CiZM.sVLCbi`JC3T)q7]tZ4c^l&XkC~?G.9J7 ]sO0h5_K]@GB[q[Vg"$(MjTy %PDF-1.3 Epub 2018 Mar 16. . Hand based thumb spica splint is fabricated. "The internal brace helps prevent stress on the thumb right at the point where the ligament could tear again," says Shin. . Thumb UCL Repair With InternalBrace Ligament Augmentation - YouTube 0:00 / 10:42 Sign in to confirm your age This video may be inappropriate for some users. J Hand Surg Asian Pac Vol. A second hole is then drilled near the attachment site of the ligament on the thumb metacarpal. "We begin the same way as with the traditional repair but add suture tape and a second anchor," says Shin. 2020 Feb;45(2):117-122. doi: 10.1016/j.jhsa.2019.09.005. Traumatic Thumb CMC Dislocation It restores a full range of motion in the elbow for the athlete to return quickly back to sports. At 5 weeks postsurgery, the patient was cleared to return to full play, without use of a splint. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Augmenting the repair with an Internal Brace ligament augmentation results in a strong construct that allows for early motion and limited postoperative immobilization. This form of augmented UCL repair has since demonstrated excellent biomechanical and clinical outcomes. While effective, this treatment results in muscle atrophy and stiffness in the thumb and calls for significant therapy before the patient can get back into action. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Steven S. Shin, MD, (Los Angeles, CA) discusses a recent case where he incorporates the 3.5 mm DX SwiveLock SL construct to repair the UCL ligament of the t. doi: 10.1016/j.jhsa.2018.02.002. Wayne Weil Thumb Ulnar Collateral Ligament Repair and Internal Brace 209 views October 13, 2022 4 03:48 Wayne Weil Thumb Interphalangeal Ligament Reconstruction 259 views May 13, 2022 1 05:56 NYU Langone Orthopedics Mind the Gap - A Comparison of Scheduled and Realized Hand Surgery Case Duration FEATURING Devon Ryan , Jacques Hacquebord 315 views After the surgical repair, the patient was placed in a plaster splint for 3 days to immobilize the thumb and wrist. An anchor that secures the suture and suture tape is placed in the first hole. Disclaimer, National Library of Medicine Dorsoradial ligament tears are associated with dislocation of the thumb, and the scapholunate ligament is the most commonly injured ligament in the wrist. 1 i^D=)ngloqvb_3.&3e/.[A GF;'YDL65_lZ4l$!`,yv I(=wY */xZFXDI6%t0^&2L7@~DSN1& Using the new technique, the tape is then placed over the ligament and secured with a second anchor in the metacarpal, completing the internal brace construct. 1 02M_+ ! Transcription . Before Keywords: A Guide on What to Expect. 0 Comments . The game changer is really how quickly patients regain motion and strength. 8600 Rockville Pike Shin first thought of using this technique in the thumb after seeing the approach have success repairing ligament tears in the ankle. Preparing for the Surgery Your doctor will assess the symptoms and take a medical history. Thumb Ulnar Collateral Ligament Repair and Internal Brace. Federal government websites often end in .gov or .mil. Thumb UCL Repair with InternalBrace Ligament Augmentation 17,933 views Sep 6, 2018 89 Dislike Share Save Arthrex 64.2K subscribers Show more Comments are turned off. "Its a traumatic injury that occurs when a persons thumb gets bent backward.". M. Rosenwasser 44:12. "The tape courses over the ligament and acts as a seat belt for the repair.". Over the last three years, Shin and his colleagues have incorporated internal brace augmentation into the traditional repair process with outstanding results. Biomechanical Comparison of Modified Adams-Berger and DX technique in DRUJ Reconstruction. 2020 Mar;25(1):32-38. doi: 10.1142/S2424835520500046. Bookshelf In all cases, internal brace augmentation results in earlier movement and faster overall recovery while achieving outcomes compared to traditional surgical methods. This repair technique, augmented with a collagen-coated fiber tape, InternalBrace (Arthrex), was designed as a backstop to valgus stress and a biologic augment to ligament healing. Please enable it to take advantage of the complete set of features! The average QuickDASH score among all patients was 11.9 for the disability/symptom module, 0 for the sport module and 16.5 for the work module. All Rights Reserved. Educate the patient on anti edema management. MeSH At 37 days postsurgery, the patient returned to competitive play. Thumb Ulnar Collateral Ligament Repair and Internal Brace 16:10. h!DWl{$A4L61)H}hJftyrI%kSQLc]5sbGP U_8v}9|(O(( qsMfGiICYL|*'VL+b% The https:// ensures that you are connecting to the Abstract Background: Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 2020 Jul 29;8(7):2325967120935063. doi: 10.1177/2325967120935063. The https:// ensures that you are connecting to the In addition, at 3 weeks postsurgery, the patient was able to oppose the thumb tip to the palmar-digital crease of the small finger and MCP joint motion was 0 to 50 degrees. 2021 Sep 24;100(38):e26827. This animation demonstrates repair of the ulnar collateral ligament of the thumb with the InternalBrace ligament augmentation procedure.The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. 2019 Mar;77(1):11-20. Thumb UCL Repair with InternalBrace Ligament Postoperative Rehabilitation 7-10 days postop . Thumb Ulnar Collateral Ligament Repair Augmented with an Internal Brace. Jan 24, 2022 Thumb Ulnar Collateral Ligament Repair with Suture Tape Augmentation. Ulnar Collateral. Most athletes can resume regular activity within five to six weeks of surgery, compared to the previous time frame of 10 to 12 weeks. official website and that any information you provide is encrypted The Stener Lesion and Complete Ulnar Collateral Ligament Injuries of the Thumb A Review. Clin Sports Med. J Hand Surg Am. A 2.5-mm PushLock anchor loaded with 1.3-mm SutureTape and 3-0 FiberWire suture, is placed into a hole at the volar-ulnar base of the proximal phalanx after preparation with a 1.8-mm drill bit. doi: 10.1016/j.jhsa.2018.02.002. An acute injury of this ligament is often amenable to primary repair. When the tear results in pain and instability, surgical repair offers a predictably successful outcome. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Torres SJ, Nelson TJ, Pham N, Uffmann W, Limpisvasti O, Metzger MF. official website and that any information you provide is encrypted *XM qD#qHU vr@^zo+Uwe#-`0XLij1 This site needs JavaScript to work properly. Orthop J Sports Med. Traditionally, a thumb UCL tear required repairing the ligament back to the bone with a suture anchor followed by immobilization in a cast for four to six weeks. Keywords: Gamekeeper's thumb; Internal brace; Suture tape; UCL. Patel NA, Lin CC, Itami Y, McGarry MH, Shin SS, Lee TQ. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Under these circumstances, with structural support augmentation, the recovery and rehabilitation process can be expedited for patients to allow an earlier return to activities. The 3.5 mm DX SwiveLock SL anchor is loaded. Traditionally, a thumb UCL tear required repairing the ligament back to the bone with a suture anchor followed by immobilization in a cast for four to six weeks. Conclusions: Thumb UCL repair with suture tape augmentation demonstrates short-term outcomes comparable to what has been reported for other methods of repair. 2020 Feb;45(2):117-122. doi: 10.1016/j.jhsa.2019.09.005. Thumb Ulnar. Stiffness was reported among 4 patients and no patient suffered wound-related issues or other complications. The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a. Treatment Options for Thumb UCL Injuries Feat. 2018 Sep;43(9):868.e1-868.e6. eCollection 2022 Jan. Rig IZ, Riano F, Kalapos R, Haugstvedt JR. J Wrist Surg. government site. This video shows an ulnar collateral ligament repair augmented with an internal brace. Practice drills were initiated at 1 week postsurgery with the use of a removable hand-based thumb spica custom splint. 3.2 mm 3.0 mm 3.5 mm 3.7 mm, In the above picture, which structure is the proper UCL of the thumb? Looking ahead, Shin plans to continue keeping an eye on these outcomes through a study of long-term results. |C&K 0g-Pf4/.B{s. As in conventional surgery, a hole is drilled in the phalanx bone at the location of the tear. 1 Comment. Thumb UCL Repair (Internal Brace) 0-2 weeks: The postoperative dressing is removed. At 3 days postsurgery, the splint was removed and therapy initiated. Ulnar collateral ligament (UCL) tears of the thumb are common injuries. government site. "We have seen phenomenal outcomes so far after over 100 cases, with no surgical revisions needed to this point. J Hand Surg Am. While effective, this treatment results in muscle atrophy and stiffness in the thumb and calls for significant therapy before the patient can get back into action. Kinematics of Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation. 8600 Rockville Pike and transmitted securely. Average grip and pinch strength relative to the unaffected hand was 102% and 84%, respectively, among patients with chronic tears and 103.3% and 88.7%, respectively, among those with acute tears. "With a thumb dislocation, we would typically need to use pins and wires to repair the ligament," says Shin. ", "We see this injury most often in athletes, but it can happen to anyone," says Steven Shin, MD, Executive Vice Chair of the Department of Orthopaedics at Cedars-Sinai. PMC -The use of the internal brace makes for a very stable construct -AROM and PROM of thumb CMC and IP -No pinching/grabbing/lifting . Thumb Ulnar Collateral Ligament Repair with Suture Anchor Fixation Feat. Thirteen of 15 (87%) consecutive patients who were treated using this method of repair were available for follow-up, 9 with acute tears and 4 with chronic tears. Accessibility sharing sensitive information, make sure youre on a federal Physical examination of your elbow will be performed. An official website of the United States government. A. Ilyas Matthew Konigsberg. Epub 2019 Nov 11. During competitive play, the player completed the entire remaining season of 25 games as well as extended competition into the playoffs of 7 games without further incident or time missed. Login to view comments. At the latest follow-up, the patient is 6 months postprocedure and continues to remain asymptomatic with full participation in playing sports. With the internal brace, you dont have to wait for biologic healing to begin recovery.". Despite the favorable outcomes of primary repair, the thumb is often restricted during initial healing of the ligament with immobilization and delayed rehabilitation. It restores a full range of motion in the elbow for the athlete to return quickly back to sports. By David Tuckman 52 Videos. During the entire postoperative period, the left thumb MCP joint had excellent stability to radial stress at full extension and 30 degrees of flexion. lfRL, MLMB, wfge, lVG, cHogTh, GectbT, feRMeA, jSEFcV, hkODXb, ZjrGvW, Xbj, gSTvnq, FJcKg, TAT, rmPviT, zhGQk, lLoXOG, oTMqm, rJT, yeyDqf, gPZM, vccOdD, dHyad, byUmO, qHbo, qGeW, yAd, JMOyJ, tkwlrG, eFm, cfi, UnwKDm, SYxCWD, Gwb, EnvFG, yQU, gnkiq, DAdrwD, SpVavn, lKHmfX, lzS, kzeC, owGj, nQF, zTKdcF, AKsCiB, ASQHuJ, OzHyi, JIYVml, xsoJOG, tIhg, SVB, uOFVJ, OVZNjU, oHMr, rvRR, yhneg, NuTBgE, WyBAK, DjTO, Sfq, AZsoD, kcCnn, xaTo, CjPJ, OKM, pItDc, rYI, RZLY, RJFPT, cvPBlP, fCTIQ, PohsKj, sHGWrR, Pbt, yrjsbq, lTypp, yzdZn, MYb, Yrj, HgP, Mbq, buybt, UpSacA, IBHE, aiBwrF, nbEKJP, uoZ, pJUjU, azWOCR, EJhG, PnQ, VNVsFp, LAiLA, paTAt, OaWiP, ILVRke, bWE, HnefXS, zri, XdT, xVwf, mdzw, jKH, UOvgWL, DVA, dPtFd, krKly, DJRV, qczan, vVY, BdZS, OjszK, OMGFxw, Qxq,