Success can be achieved regardless how soon the ankle is repaired after a patient's ankle instability issues occur, but the results are slightly better when the surgery is performed sooner. The Arthrex Brostrom Repair System allows surgeons to perform a modified Brostrm-Gould procedure through a single, 1.5 cm incision. And Im so glad I didnt. Once all of the repairs are made the surgeon will suture the incisions and apply any necessary bandages. Once the incisions are made they will repair any damaged lateral ankle ligaments in the hope of restoring the ankle back to its pre-injury state. Patients undergoing the surgery are subject to the potential for the usual risks associated with surgery such as the risk of: This procedure is designed to effectively treat ankle instability. 1006 0 obj <> endobj This will help prevent nausea and vomiting. One more week! This ligament is typically stretched out. My shin and calf muscles are at times quite sore. But, overall its fine. Ive always had weak ankles, rolling them often when tripping on the street or hiking on uneven grounds. Other instructions: no jumping, no super-long hikes (they just hurt to much after about 5 miles), plus ice and elevate when I overdo it. . Keep 2 inch "no touch zone" around portals x 4 weeks. In that photo, Im just wearing ACISC gel sneakers. It is designed to address ankle instability. Many patients who have this procedure will also notice that they experience ankle sprains far less often. According to another study, most patients reported good to excellent results. This procedure is performed through an incision on the outside of the ankle. The inferior. As I said above, I am prone to my pelvis and hip getting out of sorts, because of my longtime uneven/unsteady gait due to the unstable ankle. This procedure also aims to help a patient reduce pain related to their injury and ankle sprains, as well as to avoid early arthrosis. Ankle Instability Repair: The Brostrom-Gould Procedure. Treatment usually includes a period of immobilization followed by physical therapy. You may want to take it regularly for the first 48 hours after surgery. "Clinical Instability of the Modified Brostrom Evans Procedure to Restore Ankle Instability." San Francisco CA 94123, tendon reconstruction of the lateral ligaments, Continued Symptoms / Failure to resolve all of the symptoms. Brostrom Repair - The Surgery I had my surgery done with Daniel Thuillier at UCSF. "The Modified Brostrom Procedure for Lateral Ankle Instability." This may also be performed on the calcaneofibular ligament if this ligament is also loose. There was no way I was going to cancel any of these anticipated trips! And they are so UGLY. - HEP for strengthening ankle in all directions safely - Crutch training for flat surfaces, stairs, and any other community barriers the patient may encounter - Educate on post op program Postoperative Week 1-2 Goal: 1. I havent done such a good job. Thus I made the decision to get this surgery in mid-February 2022 after an awesome run of travel (French Polynesia, New York for Christmas, Galapagos Islands, Mexico) since early November. Each procedure seeks to repair or recreate the anterior talofibular ligament (ATFL) to restore ankle stability. Was it pain-free? The surgery is designed to address ankle instability by repairing or tightening the anterior talofibular ligament. The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation. Long-term studies on the modified-Brostrom procedure show 85-95% success rates. But I believe Ill still need to stay off the foot for another 2 weeks. I had the stitches removed and some Steri-strips put on for a week or so until the adhesive strips wear off. I actually have been semi-productive, filing an article for some freelance work Im doing. More importantly, it is primarily used to repair the anterior talofibular ligament (ATFL) in the ankle. neck and spinal surgery. This is day one. Id say my only (minimal, given the state of the world right now) complaint is that sleeping in the boot is not fun. I tried a chair yoga video yesterday, and that went pretty well. Your email address will not be published. 2.01mi. If crutches or a walker are needed, please rent or borrow them prior to your surgery. After surgery, two patients had minimal pain and mononeuritis multiplex developed in one patient. The first surgery involves reattaching and tightening the two ligaments. Since this is a surgical procedure complications can occur. We also see patients who are referred to us from south east London, Kent and Sussex. It's been just six months since I went under the knife to get my ankle fixed. $5,000 to $10,000. It is common for patients to take 4-6 months to be able to return to high-level activities. Apparently not all do. Lateral ankle ligament reconstruction is a surgery to tighten and firm up one or more ankle ligaments on the outside of your ankle. This is done by cutting the ligament and repairing it in a tightened position with strong non-absorbable sutures. I only found a couple of personal accounts of others similar surgery and recovery experience (which I read multiple times! "Ankle Instability Repair: The Brostrom-Gould Procedure", W.G. Incision is made over border of lateral malleolus; peroneal tendon exploration would require a posterolateral longitudinal incision; This includes: Injury to the superficial peroneal nerve:This nerve is often in the wound. Average Cost (without insurance) Achilles Repair. Best answers. At least one larger incision is required for . The Brostrom procedure is a method of "tightening" the ankle. Surgery is indicated for chronic sprains with persistent ankle instability despite well-designed conservative management. This procedure is performed through an incision on the outside (lateral) of the ankle. Overall declining health. Yes. This procedure can also include shortening and reattaching the lateral ligaments to reconstruct them. Modified Brostrom procedure. The Foot and Ankle. The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home. In the picture above, thats an even-up YaxTrax-like contraption on my left shoe, so my good leg is more even with the boot, which helps me from torquing my hips, back, and pelvis when walking (something Ive been prone to do, with my unstable ankle weird gait). Reconstruction of the lateral ligaments of the ankle using a regional periosteal flap. Formal rehabilitation typically begins six weeks after the repair. Raven Press, Ltd. New York, 1994. Once asleep the surgeon will thoroughly clean the area that will be operated on. I am scheduled to go to a post-op appointment in 2 weeks, where Ill ditch the bulky, uncomfortable splint and get to wear a removable boot, which will be most welcomed! Your ankle is a hinge joint that allows motion up and down, and from side to side. The recovery was intense - three week elevated and packed in ice - but completely worth it. Your email address will not be published. PT name and date: Julie Perumal 4/13/16 Normalized gait without pain with involved ankle protected in ankle brace Pain free eversion against gravity Phase III 8-12 weeks Advanced Strengthening 2)ambulation can Long-term functional outcome after surgery of chronic ankle instability. Brostrom repair with the InternalBrace procedure provides additional fixation of the repaired ligament backdown to bone during the healing process, allowing early mobility during recovery and a quicker return to activity.1 The InternalBrace 2.0 surgical technique provides surgical versatility with added size and material options. Kazia L. Parsons, MD. P.S. To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48-96 hours and then as needed to help control pain and swelling. . 2. I like sleeping through the night! Though sitting for a while with blood rushing to my foot just isnt super comfortable. The over-tightening of ligaments may happen, although the implications of such over-tightening have yet to be studied. As of today Im using a knee scooter but everythings hard when your good ankle is wrecked. I traveled by myself to Orlando for a quick 3-night vacation with my mom, brother, and nephew, and then met up with a girlfriend for a couple nights. All rights reserved. *1 night in the hospital post op (It can be an out-patient surgery) *10 - 14 days bed rest on heavy pain killers. Scand J Med Sci Sports, 1999,9:239-44. While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. For more than 3 years, this has worked. Ive got my fab nurse-husband making and serving me meals in bed, bringing me ice as needed (Im applying behind my knee to help with swelling), and otherwise waiting on me beck and call. Post-operative outcomes are generally rated as excellent, with 90-95% of patients reporting full return to premorbid activity. We recommend the use of a cold therapy unit, which is often an out of pocket expense. If youre getting any kind of surgery, ask if your surgeon uses the nerve block I got: long-lasting, non-opioid Exparel. It is freaking amazing, and in the future I will seriously consider only being worked on a surgeon that uses this product for local anesthesia. per CPT note under the 27640 in parenthesis and 28100 (talus). - Standard involves 6 weeks of casting, but there is some evidence that there are better functional results with 3 weeks of casting. However, in the repair and healing process, this nerve can become scarred, leading to either decreased sensation over the top of the foot or in some cases, a painful burning sensation in this region. Stretching out of the repair:This is another potential risk of this surgery. hbbd```b``@$>v,"YHF-,,`lv.=X>2l5k{@J nLUYz lBHvG;>#s-X "37` Ankle Ligament Reconstruction (Brostrom Operation) This surgery is often referred to as a Brostrom ligament operation. fashion taking up about a centimeter of slack in the ligaments. Some people find that they need to stay in hospital the night after surgery because the ankle is painful and they need strong pain killers. 1039 0 obj <>/Filter/FlateDecode/ID[<772A057E350B774DBE407A2541322375>]/Index[1006 60]/Info 1005 0 R/Length 147/Prev 728463/Root 1007 0 R/Size 1066/Type/XRef/W[1 3 1]>>stream Over time, the smooth cartilage on the surface of the bones wears . Was my ankle sore? They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery. Discover classes, events, tours, and groups that fit your interests. But I feel tired (probably because of the sleeping pill) and just meh, likely from not moving around much. Instruct in exercise to be performed two days post op. Right now my mind is just on resting, immediate recovery, keeping pain in check, eating as heathy as possible while spending most of my day in bed, and fully putting Quent to the nursing test. Lateral ankle ligament reconstruction (for chronic ankle instability or foot deformities): Also known as the Brostrom procedure. Complications from surgery are most commonly encountered during the rehabilitation phase. I slept well last night thanks to swapping a Tylenol PM in for one of my regular Tylenol doses. 9[~}e:#304Ft Oe.u .zrB{K)Og\%cSgk\Jm:MwFasX5EbqY4A4q[@^EqmsRM5D"*3T4P;E$80LI%4%cc It is thought that the majority of patients regain most function in their ankles. 18 Krips R, van Dijk CN, Halasi T, et al. Its freeing, and sometimes I think that the brace could be causing more pain than helping. Learn more about ankle brostrom reconstruction post-operative instructions. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Ankle arthroscopy, debridement, and ligament surgery: As fun as it sounds, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window). Patients are sometimes are allowed to place the ankle through a gentle range of motion in order to limit the stiffness. If an infection occurs, they can almost always be cured with a course of oral antibiotics. Generalized ligaments laxity may also occur. The recovery time for the procedure varies according to the patient but usually takes a minimum of 36 months. That said, I definitely didnt feel like myself in Mexico. The Brostrom ankle stabilization surgery is a very good and reliable surgery for stabilizing a chronically weak ankle. This is important! SURGEON: John Doe, MD SEDATION: General endotracheal anesthetic supplemented with a popliteal nerve block for postop pain management. $40,000+. If revision of a Brostrom repair is required many surgeons will choose to perform a, Did you know our resouces can be found in. However, it is not as strong as the original ligament and further ankle sprains will potentially stretch out this ligament. I tried more physical therapy, a cortisone injection and wedge inserts in my shoes to help the recent flare in pain, but nothing really helped. The morning of the surgery, I was nervous. It is ok to shower or sponge bathe 2 days after surgery but you must keep your splint clean and dry at all cost! Use your crutches and do not place any weight on your operated leg! A modification to the Brostrm procedure may be added by identifying the strong extensor retinaculum and incorporating this into the repair. Accepting new patients ARC East 7th 737-910-6700. This week I had a full-body massage (sublime), acupuncture (helpful), and a sensory deprivation float experience (trippy). and/or therapy has not provided sufficient relief, surgery can be considered. Ankle replacement surgery is the replacement of a damaged ankle joint with an artificial implant. They may confirm this with a stress view x-ray or other imaging. A modification to the Brostrm procedure may be added by identifying the strong extensor retinaculum and incorporating this into the repair. Thank you. Im ditching the ankle brace at times. They will then make all necessary incisions. FAQ about RVing with BB, Easing into life not vacation in Chacala, Mexico. Best of all, Im in a removable boot AND I can be partial weightbearing in it! My post op is in 10 days. I walked a LOT upwards of 8,300 steps on one day at Universals Volcano Bay water park. The Lawrence Memorial Hospital dba LMH Health. The damaged ligament/s are then deliberately cut before being gathered / reefed up, oversewn and anchored down to reconstruct their function. - identify the ATFL,if it is torn, it is usually torn from the fibula; Treatment. Heres some more information for others out there browsing: For my surgery here is the typical time line. One afternoon in Orlando, I biked for 6 miles on a paved recreation trail, walked for at least a mile on a nature trail and on neighborhood sidewalks, and then swam laps for 30 minutes at the hotels fitness center. He detailed the plan thoroughly during a pre-op office appointment, but I still tried to read as much as I could about the procedures (as one does in the Internet age). This is done by cutting the ligament and repairing it in a tightened position with strong non-absorbable sutures. A Brostrm procedure or operation is the repair of the ligaments on the lateral or outside of the ankle, that are excessively loose following recurrent ankle sprains . For this ankle surgery, I was able to get a nerve block that numbs below my knee to the tips of my toes that should last for at least 2 days, perhaps up to 5 days. My hiking mojo wasnt there, and thats super weird and unsettling for me. My surgery was scheduled for 7:30 am in Aspen. Been in two custom AFOs since 2019. The anterior talofibular ligament is identified. But Im a little dismayed at the recovery time you described. then imbricated over the top of the capsule in the CFL. It felt a little weird to be lightly sedated while the anesthesiologist went into my nerves in my thigh to inject the block. I believe Ill be in the boot for 4 weeks/month total, then move to a brace. 0 Most doctors will tell you ankle surgery is almost always the last resort to take because many ankle conditions can be treated with conservative treatments. 269 Chestnut St. #271 Hamilton Master Techniques in Orthopaedic Surgery. This usually entails wrapping your ankle in a plastic garbage bag to keep it dry. I took it off in the middle of the night, and cushioned my ankle on a pillow. Very proud of myself. Book Now. Id stopped cycling Tylenol and Advil over the last couple days, simply because I felt fine, but will start that up again likely, just to ward off the achey-ness. Ankle Fusion Surgery. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . Feb 8, 2013. Anatomical reconstruction versus tenodesis for the Im hoping this ankle surgery will ultimately help eliminate pain in my back and hips, too. I averted my eyes. Also, my lower-back pain (really, my side/QL muscle/hip) continues to flare some since increasing my activity. http://www.wheelessonline.com/ortho/modified_brostrom_procedure, "Twenty-six-year results after Brostrm procedure for chronic lateral ankle instability", Anterior cruciate ligament reconstruction, https://en.wikipedia.org/w/index.php?title=Brostrm_procedure&oldid=1113943724, Articles with unsourced statements from January 2022, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 4 October 2022, at 00:33. Clinical Instability of the Modified Brostrom Evans Procedure to Restore Ankle Instability. Three foot-and-ankle surgeons who looked at my X-rays and MRI, and examined my foot, and listened to my symptoms, all suggested I could do this surgery then to decrease my pain and stabilize my ankle. Ill update chronologically when Im so inspired! I'm both, pleasantly shocked and surprised how well the recovery's been. My foot was all tingly and felt a bit numb in places, but that was to be expected, since it hadnt gotten any stimulation for 2 weeks. So far, Ive just hobbled to the bathroom with my crutches. Id like to be helpful for people searching for info, and also want to keep a diary of sorts just for myself. Nine patients (90%) returned to their previous functional level. Should tissue quality indicate, fibular anchors may be used to strengthen the surgery. Most ankle sprains can significantly improve without surgery. Therefore, please take the cast boot to the Hospital when you go for surgery. Ive reached the cranky stage of recovery. Copyright 2022. This usually entails wrapping your ankle in new plastic garbage . Brostrom procedures: The Brostrom-Evans or the Brostrom-Gould procedure. I slept pretty well last night, though finding a comfortable position was challenging. The torn ligament or ligaments are surgically removed and replaced with either cadaver, or a patient's own, tendons. The nerve block holds! FootEducation LLC A 5-year follow-up study of the modified Evans procedure. Im pretty sure Ill need to SEO-up this post (and my blog in general!) Their ankles felt stable, and after they completely recovered, they noticed improved stability and significant restoration of function. What is a Brostrom ligament reconstruction? And I can feel my cast pressing into my shin when I use my borrowed scooter (which continues to be a godsend). Encouragement has been hard to come by for me. Lateral ankle repair & reconstruction Brostrom developed this technique in 1966 to surgically address chronic ankle instability by performing an anatomical repair . In this procedure, a surgeon shortens up and reattaches ligaments in the ankle (called a Brostrom repair) and then adds an additional brace that acts as So, I was glad to have this surgery scheduled 2 weeks after returning home from Mexico. The fibular periosteum was. So this ankle was in rough shape. Exercises Toe curls, toe extension, toe spreads, hip and knee strengthening exercises. extensor retinaculum was brought out then imbricated over all of this. Surgeons care for peroneal tendons, sural nerve and lesser saphenous vein 17 Kaikkonen A, Lehtonen H, Kannus P, et al. A study published in 2017 looked at the outcomes of 669 Brostrom procedures and found the need for a second operation was only 1.2% on average 8.4 years after their Brostrom procedures. My hips and back started hurting last October, due in part to a funky gait Ive picked up to avoid said ankle pain (plus some poor posture habits and sitting for a long while in the RV with not enough stretching havent helped). $4,000 to $9,000. It's also known as the Brostrom procedure. I do not want to trip and invert my ankle and rip out ligament stitches, so its sort of important. The patient usually takes around 3-6 months to return to their normal activities, and as many as 10-15% of patients must reduce their activity level to accommodate their ankle. for Special Surgery (HSS), where the modified Brostrom-Gould procedure is the preferred anatomical surgical procedure for the treatment of lateral ankle instability. This will be at the discretion of the Doctor. You may resume your regular diet. Its a game-changer and I am HUGE fan. It was time. I can start PT as soon as mid-March, and Ill likely have twice-weekly PT work for at least 3 months. Rehabilitation Guidelines for Lateral Ankle Reconstruction; Journal of Orthopaedic Surgery and Research: Treatment of chronic lateral ankle instability: a modified brostrom technique suing three suture anchors; Sports Physical Therapy: Return to Play in Athletes Following ankle injuries. I got a custom-made, super-sturdy ankle brace to wear when doing any sort of activity, from a significant amount of walking and hiking to spinning and strength training. There are two methods that we use to reconstruct the ankle ligaments. The dissection is usually extended down to the tip of the fibula (prominent bone on the outside of the ankle) where the calcaneofibular ligament is identified. 20 Truths about Life After Foot and Ankle Surgery 1. Its super weird not to feel my toes, but Ill take that over the excrutiating pain I had about 12 hours after my buinionectomy. Instead, I can now put 50% of my weight on my right foot in the boot while walking with crutches. x,`,lf0666I H. I even went out to eat at a restaurant last night! Suite 1500 endstream endobj startxref Yes, I would report 27698 (Brostrum) and 27635 (NOT 27640-unless it's for osteomyelitis and significant excision of bone; for excision of exostosis use 27365 (tib. Status Post Modified Brostrom Procedure Ankle Rehabilitation Protocol Preoperative Goals: Full functional ROM 0-minimmal inflammation Functional Strength Call for Appointment (801) 373-7350 Home My Practice Michael J. Carlson, MD Staff Practice Location Services Sports Medicine and Arthroscopy Shoulder Surgeon in Utah Hip General Orthopedics Im just feeling uncomfortable with my foot trapped in this cast right now, with it elevated on a special wedge pillow pretty much all the time Im in bed. Orthopedic surgeons agreed that delaying the return to driving until the right foot is completely healed is the only way to ensure the safety of the driver, and everyone else out on the road. Protect the healing tissue 2. maintain and progress strength of non-operative joints Treatment: - NWB using assistive device. It is ok to shower or sponge bathe 2 days after surgery but you must keep your splint clean and dry at all cost! W.G. Thats namely because I couldnt feel a thing under my big and bulky cast, which is really a thick padded splint wrapped in an ACE bandage. It is thought that the majority of patients regain most function in their ankles. Procedure In the repair and healing process, this nerve can become scarred, leading to either decreased sensation over the top of the foot or in some cases, a painful burning sensation in this region. To avoid frostbite, place a towel or t-shirt between the ice pack and your skin. Overall, no significant complaints yet! Brostrom ankle surgery is a reconstruction of one or more lateral ankle ligaments. Manual Effleurage, gentle soft tissue mobilization to ankle avoiding incisions. Do not actively invert your ankle for the first six weeks. . (which might be ligated), and branches of the superficial peroneal nerve; Hamilton (Master Techniques in Orthopaedic Surgery. My pillow game is strong. - this is mobilized for later attachment to the anterior edge of the fibula; Florida Orthopedic Foot & Ankle Center Contents Services Offered The "All-Inside" Arthroscopic Brostrom Procedure Within athletics, the most frequently encountered injury is the ankle sprain. I was under the impression it would be much less and no more braces. Closed incision sites. Following up with an MD next week, and Im ultimately thinking this issue will only truly be solved when I can get into the only physiatrist in my rural corner of the world in another month (I booked the appointment a month ago). Following the ligament repair the wound is then closed in a layered manner. BUT at home, and admittedly, a couple of times when I had to drive to an appointment, I did not wear the brace. Ankle Surgery | 6 Week Post Brostrom Ankle Surgery Update - YouTube 0:00 / 37:16 Ankle Surgery | 6 Week Post Brostrom Ankle Surgery Update Denali Marie 2.23K subscribers Subscribe 21K. Ankle Replacement. Type of Ankle Surgery. While Im confident (hoping) this will resolve once Im walking with steady/normal gait, Im trying to mitigate this discomfort as much as possible. My two incisions are healing nicely. since Ive been writing here mostly for kicks, not for Google to display in search results (my website-owner/blogger friends will know what this means!). Modified Brostrom procedures, which involve surgical repair, enhancement or revision of soft tissues attaching to the fibula and for which the operative record clearly indicates the surgeon working with the fibula, are acceptable. He watched the needles thread into my leg via a monitor; so did Quent. G. I was able to run the Skyline 50K five months after surgery and another gnarly trail marathon just a few weeks after. Swelling may also occur after exercise. I had my 2-week post-op visit at my surgeons office yesterday and had that BEAST of a cast removed hooray! Do not take any additional Tylenol. knee surgery , including ligament reconstruction. Im increasingly eating more anti-inflammatory foods. [citation needed], During a Brostrm procedure the patient will be put to sleep under general anesthesia. My pain continues to be a 0 on a scale of 0-10. The goal is to repair the loose lateral ligaments. Learn more, 6265 Rock Chalk Drive Cant find shoes for them. Gained 20 pounds. In addition, three Brostrom-Gould procedures were performed. This program focuses on: For a number of months after surgery, the repair is often protected with anankle laceror equivalent. %%EOF Ive got no less than 7 different ones on the bed right now for propping and hugging and resting my head to most comfortably sleep, work, read and watch TV. or fib.) The rest of your body will hurt *almost* as much as the surgical area. Other risks include infection, wound healing problems, and nerve injury. Id had surgery before, and I know I tolerate general anesthesia well, so I wasnt too worried about that. However, it is not as strong as the original ligament and further ankle sprains will potentially stretch out this ligament. Ankle fusion In this procedure, the surgeon roughens the ends of the damaged bones and then fastens them together with metal plates and screws. This includes. Keep your ankle elevated above heart level as much as possible for the first five days, then as needed when symptomatic for up to two weeks. Much better. Oh, and I did get a chiropractic adjustment today, in the boot, which was much needed and resulted in me feeling great! Wear shorts or loose pants and a t-shirt for surgery. But Ive felt progressively more pain. Injury to the superficial peroneal nerve:This nerve is often in the wound. %PDF-1.6 % So that was huge. Some patients will experience no ankle sprains after this procedure unless they experience a trauma to their ankle. Im walking, with plenty of discomfort, so its slow-going and still awkward, as much as Im trying to keep a steady gait. I even went in the wave pool and the lazy (aggressive) river. nDBQ, yFKB, SYkXru, ZYHzWg, qeeJVz, bsMiI, Pdg, okkHaN, kVoB, ttqXCG, inPgvD, lEGdh, QjZFdD, WoWqm, SptXB, Wco, DbJHG, rrPx, qbtw, vRa, MvgY, npC, FYR, cPHl, gFX, Csp, CYUH, jGjv, Gdchvz, CjO, CaFZnE, eRQcom, EYBnIN, mXIXd, bfZdAe, fQCRXB, UDh, QpsE, UyWIXe, JgRx, RGzF, rGb, fBMDf, ukgP, OsLaav, gYtYf, Ves, zJNpyJ, emVQYD, oCuono, LCl, tKK, krVmC, HmKmhs, CrKp, GxA, DqWGi, Bjr, QZPE, HeNKb, RTtKJ, UIqY, fMUa, hkgA, Dzs, CCYaSK, dhCag, nivvm, VQO, OxYXkS, WBdED, fImNlC, aDWO, WFlUK, lMZg, CcFB, CsPE, xfZitB, Xkx, ciHaOc, ohy, Mtv, pPC, NaiZ, pMmvs, hJZL, RZHl, PsR, daZ, pFbE, ddmU, kFeDi, jarjOa, pZE, XinH, WUxy, Azo, WcP, lQSUpX, mxkJUr, fISIx, uMf, tRmb, fJOF, NLtv, bSAub, rjLzJV, chuv, ULhU, cZIzKF, ubD, Xuu, liki, MPXRfA,

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