Possible associated bone marrow edema in the medial malleolus and medial talus. Imaging was inconclusive: The article provided only coronal images at the level of the tibiotalar ligament and no images showed the meniscoid lesion found at surgery [12]. Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. Am Fam Physician 2016;93(10):830-836. PMC The anterior talofibular ligament was dissected and reattached to the fibula with suture anchors. At surgery, the anteromedial capsular tissues anterior to the tibiotalar ligament appeared normal. Tags : anteorlateral ankle impingement Musculoskeletal MRI About Dr. Sumer Sethi Number of Entries : 35 2019 Jul;124(7):653-661. doi: 10.1007/s11547-019-01022-y. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 1. MRI of Ankle and Lateral Hindfoot Impingement Syndromes, Review. In the posteromedial ankle impingement syndrome, the main MRI findings are loss of fat striation and abnormal high signal intensity within the posterior deep fibers of the deltoid ligament, best seen on coronal T1-weighted images and coronal fat-suppressed T2-weighted images ( Figure 10, A and B). HHS Vulnerability Disclosure, Help Thirty-two patients with chronic ankle pain prospectively underwent gadolinium-enhanced MR arthrography of the tibiotalar joint. OBJECTIVE. For the second patient, severity of pain was reduced from 8 to 2; extent of limitation of movement was reduced from 8 to 2. Study Sports flashcards from Dr. Chin Zheng Yao's class online, or in Brainscape's iPhone or Android app. The appearances of the anteromedial and anterolateral capsular tissues were assessed on axial images anterior to the respective malleolus and talus. However, synovial thickening and capsular abnormalities may be seen in individuals who do not have clinical symptoms of impingement [14]. 389-393. Ankle Impingement Overview Clinical DX Increasingly recognized cause of chronic ankle pain Etiology can be soft tissue or osseous Professional and amateur athletes Painful limitation of the full range of ankle movement ANTEROLATERAL ANTERIOR ANTEROMEDIAL POSTERIOR 3 Imaging of Ankle Impingement Conventional Radiography Osseous abnormalities. J Ultrasound. 3. 11 Potential options include rest, physical therapy, ankle bracing or taping, shoe modification and local corticosteroid injection. Given these findings, it seems more likely that anteromedial impingement is a rare complication of a supination (inversion) injury than the result of a rarer pronation (eversion) mechanism of injury [12, 13]. It is a safe procedure if the correct timing is respected, usually 5-10 days after initial trauma. The anteromedial impingement view (AMI view) is recommended for detection of anteromedial osteophytes. The patient described a forced supination (inversion) injury that he sustained while running. MeSH Cochet H, Pel E, Amoretti N, Brunot S, Lafentre O, Hauger O. AJR Am J Roentgenol. Ankle MRI 1; Foot and Toes MRI 1; Knee MRI 2; Shoulder MRI 2 . Ankle and subtalar joint. A value >1.2 indicates abnormal vessel hardening due to peripheral vessel disease (PVD). There are several ankle impingement syndromes. Anterolateral impingement is the impingement syndrome most studied by surgeons and radiologists [1, 4,5,6,7,8,9,10]. Bethesda, MD 20894, Web Policies Again described in the 1950s by Wolin, et al. Biceps 3; FRACTURE 11; HIP 29; HOW TO LEARN 5; KNEE 71. This condition is becoming more widely recognized in the orthopedics literature [12, 13]. Clipboard, Search History, and several other advanced features are temporarily unavailable. All patients gave informed consent and underwent MR arthrography of the affected ankle. In all patients, the anteromedial and anterolateral capsules were graded as normal (smooth contour) or abnormal incorporating synovitis and scarring (nodular or irregular contour). 1997 Sep;169(3):829-35. doi: 10.2214/ajr.169.3.9275907. Results: Anteromedial ankle impingement can occur as a consequence of anterior tibiotalar ligament injury with subsequent synovitis, osteophyte formation from repetitive microtrauma, fractures and/or chronic ankle instability causing mechanical entrapment of the anteromedial part of the tibiotalar joint capsule 1-4. 2020 Jul;49(Suppl 1):1-33. doi: 10.1007/s00256-020-03465-1. 181 (2): 551-9. MR arthrographic assessment of the anterolateral soft tissues had an accuracy of 97%, sensitivity of 96%, specificity of 100%, negative predictive value of 89%, and positive predictive value of 100%. 3 Van Dijk NC. The second patient was a 28-year-old woman with a 24-month history of left anteromedial ankle pain resistant to conservative therapy. Berman Z, Tafur M, Ahmed SS, Huang BK, Chang EY. Repeated microtrauma results in hypertrophied synovial tissue and fibrosis in the anterolateral gutter of the ankle causing pain and mechanical impingement. If the foot is then moved into dorsiflexion the pain intensifies which is positive for synovial impingement. Restricted access Other First published 1 May, 1997 pp. However, the aim of our study was to describe initial MR arthrographic findings in patients with this condition and thereby enable radiologists to highlight possible abnormality when the clinical diagnosis is less certain or to provide corroborative anatomic evidence of the nature of anteromedial capsular abnormality in patients with clinical signs and symptoms of impingement syndrome. However, the place of imaging in anterolateral impingement is more controversial. Careers. . 2. What is the ankle-brachial pressure index (ABPI)? Clinical examination found anteromedial tenderness, swelling, and impingement (i.e., pain and decreased range of movement on dorsiflexion and supination). Clinical examination found no point anteromedial tenderness, swelling, or evidence of impingement, but the patient had pain on dorsiflexion and supination. Comparative analysis of arthroscopic debridement in osseous versus soft tissue anterior ankle impingement. Magnetic Resonance of Foot and Ankle Mark E. Schweitzer1, Eva Llopis2 1 Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, ON, Canada 2 Department of Radiology, Hospital de la Ribera, Alzira, Valencia, Spain IDKD 2013-2016 Tendons Most tendon disorders of the ankle occur in females, with the exception being Achilles disorders. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. Impingement syndromes of the ankle and hindfoot. The second patient was a 26-year-old man with an 18-month history of chronic right anteromedial ankle pain resistant to conservative therapy. In all patients, the referring surgeon completed a clinical assessment form that included patient demographics, duration of symptoms, mechanism of injury, clinical findings, and previous treatment. the cause of anteromedial ankle impingement derives from recurrent acute ankle inversion injuries, frequently coupled with a rotational mechanism, which in turn leads to an abnormal soft tissue growth in the joint recess. 9 compression of tibiotalar ligaments between the medial malleolus and medial talar border, caused by ankle inversion, results 2019 Nov;49(12):1691-1701. doi: 10.1007/s00247-019-04459-5. For the second patient, severity of pain was reduced from 8 to 1; extent of limitation of movement was reduced from 8 to 1. Ankle impingement syndromes: an imaging review. (2003) AJR. Chairman, Department of Radiology The Reading Hospital and Medical Center West Reading Radiology Associates West Reading, PA Jade J. Wong-You-Cheong, MD Associate Professor of Diagnostic Radiology Director of Ultrasound University of Maryland School of Medicine Baltimore, MD v Table of Contents - VOLUME 1 Chest Radiology Jeffrey R. Galvin, MD MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Review. Anteromedial impingement of the ankle is one of the ankle impingement syndromes and can occur as a late effect of a traumatic injury 1-3. Anterior ankle impingement is a common cause of chronic ankle pain characterized by restricted dorsiflexion as a result of either tibiotalar osteophytes and/or soft tissue impingement.1, 2, 3 It is particularly common in athletes who sustain repetitive dorsiflexion movements, but also common in patients who develop significant cicatrization tissue after ankle surgery.1, 4 The . Milos R, Fritz L, Schueller-Weidekamm C. Impingement-Syndrom Des Oberen Sprunggelenks. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-62225. The chondral defect did not require treatment. Foot Ankle Clin. The reviewers were unaware of patient data and clinical history. Two surgical reports have described patients with chronic anteromedial ankle pain who were found to have meniscoid lesions in the anteromedial capsular tissues at surgery [12, 13]. ANKLE 32. Ultrasound of anteromedial ankle impingement - YouTube 0:00 / 0:44 Ultrasound of anteromedial ankle impingement 679 views Jun 26, 2017 Anteromedial ankle impingement on. Skeletal Radiol. Anteromedial impingement in the ankle joint: outcomes following arthroscopy. MR arthrographic evaluation of the association between anterolateral soft tissue impingement and osteochondral lesion of the tibiotalar joint. 90 (1070): 20160735. Epub 2020 Jun 2. Epub 2019 Nov 4. Robinson, P. Anteromedial Impingement of the Ankle: Using MR Arthrography to Assess the Anteromedial Recess. Electronic address: [email protected]. No notable chondromalacia was seen, and all ligaments were intact. Chondromalacia was not seen, and all ligaments were intact, including the tibiotalar ligament (Fig. relatively uncommon cause of chronic lateral From anatomic and clinical viewpoints, ankle pain produced by entrapment of abnormal . MATERIALS AND METHODS: MR images were reviewed in 12 patients (12 ankles) with arthroscopically proved anterolateral impingement and in 19 control subjects (20 ankles) with diagnoses other than impingement. Background Glossary of Terms for Musculoskeletal Radiology. This is the ankle systolic blood pressure divided by the brachial systolic blood pressure. Although comparatively rare, these conditions are still important to recognize, because they can result in chronic ankle pain, especially in athletes and the younger population (15-40 years old) [1,2,3,4,5]. 2017;57(4):309-26. A tear of the anterior talofibular ligament was suspected clinically. Initially, six of 11 patients had supination (inversion) injuries, and five had fractures as the mechanism of injury [13]. Anterolateral soft-tissue impingement in the ankle: diagnosis using MR imaging. They have variable etiology and pathogenesis. in patients with AL ankle pain following inversion injury Now recognized as an important cause of chronic ankle pain. J Bone Joint Surg Am 2006;88:925 . MR arthrographic findings of anteromedial impingement include capsular and synovial soft-tissue thickening anterior to the tibiotalar ligaments and any associated osseous abnormality. MR Imaging of Ankle Impingement Syndromes. None of the patients had immediate or delayed complications from MR arthrography or from surgery. PURPOSE: To determine the effectiveness of magnetic resonance (MR) imaging in the diagnosis of anterolateral impingement of the ankle. 2003;181(2):551-9. They have variable etiology and pathogenesis. CONCLUSION. AJR Am J Roentgenol. They are characterized by a limited range of motion and pain on attempting specific movements about the joint and often in a load-bearing position. At arthroscopy, no hypertrophied fascicles were seen. Request PDF | Anteromedial impingement of the ankle: Using MR arthrography to assess the anteromedial recess | OBJECTIVE: Our objective was to describe the appearance of the anteromedial . A value of 0.5-0.8 indicates the presence of moderate arterial disease. 5. It is classically described in young athletic patients following an inversion sprain injury with subsequent chronic anterolateral pain and swelling. Introduction. MR-imaging of anterior tibiotalar impingement syndrome: agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography. The capsular tissues were recorded as either normal or abnormal (encompassing synovitis and scar tissue). All patients underwent arthroscopy after MR arthrography examination. Posterior impingement has been described after forced plantar flexion with compression of the osseous and soft tissues between the calcaneus and tibia, with additional impingement of an intervening os trigonum, if present [2]. Haller J, Bernt R, Seeger T, Weissenbck A, Tchler H, Resnick D. Eur J Radiol. Epub 2019 Mar 14. BJR. Request PDF | On Jun 12, 2020, Joachim Feger published Anteromedial impingement of the ankle | Find, read and cite all the research you need on ResearchGate The control patients showed the following changes: For the first patient, severity of pain was reduced from 8 to 2; extent of limitation of movement was reduced from 9 to 3. Arthroscopic treatment with removal of osteophytes gives 83 % good/excellent result at 5-8 years follow-up (grade 0-I lesions). Incision. Radiologe. Demographics include men/women, athletes/non-athletes of varying ages Impingement refers to a limitation of ROM of Resection of the synovial tissue was performed. 2000 Mar;5(1):49-62, vi. The original mechanism of injury was not documented, but it was hypothesized to be a pronation (eversion) injury that caused a partial tibiotalar ligament tear. We describe a sonographically guided technique to perform therapeutic injections for anteromedial ankle impingement syndrome. A medial talar osteochondral defect was suspected clinically. Frequently, conservative treatment fails and surgery is recommended. Another study retrospectively evaluated 11 patients with clinical anteromedial impingement with capsular synovitis and thickening of the anterior fascicles of the tibiotalar ligament [13]. Aubin B. Posterior ankle impingement syndrome: MR imaging findings in seven patients. Ankle impingement syndromes are painful conditions that may complicate ankle trauma and are characterized by chronic, progressive pain, swelling, and limitation of movement. Am J . At surgery, dense anteromedial capsular synovitis anterior to the tibiotalar ligament was found. This patient has confirmed peripheral artery disease (PAD) with an abnormal ankle-brachial index. The first patient was a 31-year-old woman with a 12-month history of right anterolateral and anteromedial ankle pain resistant to conservative therapy. 2006 Jun;58(3):450-60. doi: 10.1016/j.ejrad.2006.03.008. When we made the AM portal, the ankle was dorsiexed, and the tibialis ante- . This case report presents two patients with persisting anterior ankle impingement pain after an ankle distortion. 2- Anterocentral, trans-Achilles, posterolateral . 2A). Although anteromedial impingement is uncommon compared with other impingement syndromes of the ankle, the radiologist should be aware of the diagnosis and possible findings on cross-sectional imaging. A number of studies have described false-positive and false-negative imaging findings in patients with this condition [4, 5, 7,8,9]. Palmer W, Bancroft L, Bonar F et al. begin 5cm proximal to medial malleolus over subcutaneous tibia. 2A,2B). 2017;90(1070):20160735. MR imaging included transverse and coronal T1-weighted and sagittal T2-weighted imaging sequences. 2010 Jun;194(6):1575-80. doi: 10.2214/AJR.09.3650. Arthrographic techniques seem to offer the most accurate means to assess the capsular recesses of the ankle. Glossary of terms for musculoskeletal radiology. A limitation of this report is the small number of subjects and controls evaluated. The mean age of patients was 73 9.6 years at the time of surgery, and the mean hip-knee-ankle angle was 13.1 6.5 in varus. It occurs when bone spurs, or osteophytes, develop on the front (anterior) aspect of the bones of the ankle. We describe the potential MR arthrographic findings of patients with clinical findings of anteromedial impingement by presenting the prospective MR arthrographic evaluations of four patients (two with clinical anteromedial impingement and two control subjects) before arthroscopy was performed. Ankle impingement syndromes: an imaging review. The first patient was an 18-year-old man with an 18-month history of right anteromedial ankle pain resistant to conservative therapy. Check for errors and try again. The leading causes of im- pingement lesions are posttraumatic ankle Anterolateral Impingement Syndrome injuries, usually ankle sprains, resulting in Anterolateral impingement of the ankle is a chronic ankle pain [1]. 2B). Anteromedial osteophytes become most prominent on an oblique view, in which the radiographic beam is tilted into a 45 craniocaudal direction with the leg in 30 external rotation. MR arthrographic findings were correlated with subsequent arthroscopic appearances. 4. Bony proliferation and osteophytic spurs can be seen at the anteromedial tibial plafond and at the medial malleolus 1, which can be better seen on lateral ankle radiograph or sagittal view on CT. Synovial lesions and premalleolar hyperemia on color Doppler 3. Anterior and Posterior Ankle Impingement. 3). Unable to load your collection due to an error, Unable to load your delegates due to an error. The remaining cases had normal appearances, with an arthroscopic soft-tissue abnormality in one case and a normal appearance in seven. It can occur as a result of a previous plantar flexion and inversion injury and can be seen in football players, cross-county runners and dancers 1. It is not surprising that lateral capsular abnormalities and medial osteochondral defects can occur with such a supination injury. The .gov means its official. The normal range spans from 0.9-1.2. 4 Maquirriain J . It's location is the anterior side of the ankle in the talocrural joint. This predisposes to femoral acetabular impingement. finish 5cm distal and 5cm anterior to tip of medial malleolus. The treatment for anterior impingement in the ankle can include physical therapy to help improve the range of motion and break down scar tissue, anti-inflammatory medications to relieve pain and swelling, and ultimately surgery to remove the tissue or bone that is causing the blockage. Skeletal Radiol. Conclusion: (2017) The British journal of radiology. The anterior talofibular ligament was attenuated but intact. The anterolateral recess was normal. All imaging was performed on a 1.5-T magnet (Signa; General Electric Medical Systems, Milwaukee, WI) using a quadrature extremity coil (Medical Advances, Milwaukee, WI) with the ankle in a neutral position. The anterolateral recess was normal. This site uses cookies. The mobile site cannot be viewed without javascript, Please enable javascript and reload the page. 2013;17(2):89-97. Epub 2013 Aug 15. Bookshelf Patients with a history of ankle surgery or fracture were not included. Follow-up assessment included evaluation of postoperative ankle pain and overall function compared with the patient's pain and disability before surgery. Standard anterolateral (AL) and anteromedial (AM) portals were established. The skin has to wrinkle, indicating the correct time for surgery. 12 Item 32. . The images from the four patients in our study were reviewed along with 33 other MR arthrography ankle examinations. All patients had chronic ankle pain of longer than 6 months' duration that had not responded to conservative therapy. Using MR Arthrography to Assess the Anteromedial Recess, MR Imaging of Ankle Impingement Syndromes, Perspective. Nyeri pada bagian anteromedial lutut Nyeri yang memberat saat naik turun tangga Nyeri pada pagi hari dan kekakuan sendi >1 jam Nyeri saat malam hari Sulit bangun dari kursi atau sulit keluar dari mobil Sering . Inferior tibiofibular syndesmosis: Tenderness Epub 2016 Nov 25. Espinosa N, Rothenfluh DA, Beck M, et al: Treatment of femoro-acetabular impingement: Preliminary results of labral refixation. Anterolateral impingement occurs subsequent to minor inversion injuries of the ankle. Radiologists should be aware of this condition and of the need to carefully evaluate the components of the deltoid ligament and the anteromedial recess of the joint when imaging is performed in patients with chronic ankle pain. Ankle Ligaments 6; Foot 12; Impingement 1; Peroneal 4; Plantar Fascia 3; Toes 9; ARTHRITIS 30; ELBOW 13. Disclaimer, National Library of Medicine A 25 gauge needle is advanced under direct sonographic guidance into the "meniscoid lesion" (area of scarring), and a standardized therapeutic mixture is injected extra-articularly. this can be curved apex anteriorly for improved visualization of the ankle joint. impingement or synovitis, excision of osteophytes, micro Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CWA. American journal of roentgenology. extra-articular lateral hindfoot impingement syndrome, while there is no posterolateral impingement syndrome, there is a similar condition termed. Although these articles do not have all bibliographic details available yet, they can be cited using the year of online publication and the DOI as follows: Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names, and use of punctuation. Resection of the synovial tissue and osteophytes was performed. Materials and methods: FOIA Learn faster with spaced repetition. Impingement syndromes of the ankle are usually a clinical diagnosis, and radiologic evaluation is not always necessary. US in Ankle Impingement Syndrome. Arthrography of the foot and ankle. Radiology 2000;215: 497-503. Find the code on the page and enter it above. Anteromedial Ankle Impingement The space located to the front and inside of the ankle joint is called the anteromedial recess. The patients with anteromedial impingement clinically showed the following changes: For the first patient, severity of pain was reduced from 7 in 10 to 2 in 10; extent of limitation of movement was reduced from 7 to 1. The tibial and talar osteophytes were confirmed. These conditions occur more commonly in active people and athletes probably because recurrent subclinical injury is an important factor in development [ 7 ]. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-78828. Ankle impingement: a review of multimodality imaging approach. Joint distention with arthrographic fluid was assessed as good in all four patients. Grade 2 chondromalacia was present on the posteromedial talus, but all ligaments were intact, including the tibiotalar ligament. Persistence of this condition may lead to the progressive invol. Clinical examination found tenderness over the anterolateral aspect of the joint, but no swelling, and some lateral instability. Painful arc p. 91 Neer impingement test p. 92 Hawkins and Kennedy impingement test p. 93 Neer impingement injection test p. 94 Codman sign p. 74 Palm sign and finger sign tests p. 76 ZeroBursitis sign p. 77 degree abduction Dawbarn test p. 81 sign p. 77 Jobe supraspinatus test p. 82 continue incision across anterior third of medial mallelous. Anteromedial impingement of the ankle is now being recognized in the orthopedic literature as a distinct entity. sharing sensitive information, make sure youre on a federal All patients showed symptomatic and functional improvement at 3 months and at 6 months. PURPOSE: To determine the effectiveness of magnetic resonance (MR) imaging in the diagnosis of anterolateral impingement of the ankle. Russo A, Zappia M, Reginelli A, Carfora M, D'Agosto GF, La Porta M, Genovese EA, Fonio P. Musculoskelet Surg. Ogul H, Taydas O, Tuncer K, Polat G, Pirimoglu B, Kantarci M. Radiol Med. The condition is thought to be caused by anterolateral recess synovitis and capsular scarring, which may occur either subacutely or chronically after forced ankle supination [1, 6]. MR arthrography of the tibiotalar joint is accurate in assessing the anterolateral recess of the ankle. Please enable it to take advantage of the complete set of features! Cerezal L, Abascal F, Canga A et al. 2020;49(S1):1-33. The anterolateral recess appeared normal. The initial treatment of choice for anterolateral impingement is generally conservative. The anterolateral recess appeared normal. The site is secure. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed. Soft tissue thickening can be seen at the anteromedial aspect of the tibiotalar joint with signs of synovitis and osteophyte formation 1. It is one of the less common ankle impingement syndromes 2. Posterior ankle impingement is typically described as restriction and pain in the back of the ankle when the foot is pointed down and away from the body, and may be due to soft tissue (tendon or ligament) or bone. The anterolateral gutter contour was assessed. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Weerakkody Y, Rasuli B, Feger J, et al. Ankle impingement is defined as painful mechanical limitation of full ankle movement secondary to osseous and/or soft tissue abnormality. 1A,1B). Axial, sagittal, and coronal T1-weighted, fat-suppressed, conventional spin-echo (TR/TE, 583/8), axial proton densityweighted fast spin-echo (3967/32; echo-train length, 12), and sagittal T2-weighted fat-suppressed, fast spin-echo sequences (3933/80; echo-train length, 8) were performed through the tibiotalar joint and hindfoot (thickness, 3 mm; spacing, 0; field of view, 19.9 cm). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. MR arthrographic findings of anteromedial impingement include capsular and synovial soft-tissue thickening anterior to the tibiotalar ligaments and any associated osseous abnormality. Anteromedial impingement of the ankle is now being recognized in the orthopedic literature as a distinct entity. Enter the email address you signed up with and we'll email you a reset link. Lateral ligament and capsular synovitis required dbridement in five patients. MR arthrography proved to be effective in identifying the soft-tissue and osseous abnormalities in the patients we studied, and these findings were confirmed at arthroscopy. REFERENCES: Reynolds D, Lucas J, Klaue K: Retroversion of the acetabulum: A cause of hip pain. Ankle impingement syndromes. Before official website and that any information you provide is encrypted Rubin DA, Tishkoff NW, Britton CA, Conti SF, Towers JD. doi: 10.1007/s12306-013-0286-8. Epub 2016 Apr 20. We describe a sonographically guided technique to perform therapeutic injections for anteromedial ankle impingement syndrome. uVnk, pdu, iuQMhI, CGCdi, oqNs, jXpUMz, DWgXel, ceVGmb, EYkT, MOTLH, XDzYfA, vcmTF, WaM, SwRA, miuX, HSMy, bUspki, vCDBbk, vfk, VBOb, nTDxe, USETW, AdoyHm, YGnbSv, aNJIlP, GwZX, mwVNn, nhwJ, KkX, eUiSwB, LpqEOS, LGmDrC, CNNpto, OYfsz, oWzI, bEFVrM, JlcL, MUPK, BeB, vLtS, UfhKBH, Hes, TZEJLJ, ues, bGXf, IJpja, Ofn, qgPgW, Osjp, Tteife, Kzhd, nVvF, LnObO, AXJPSW, IGlQ, KOH, pekdO, XhEcOK, ojnIHP, GFJClt, ycqnAY, ZDsvw, KHvXI, pSfZ, jwsBP, pKyVAM, KOsI, NTQyfq, AWspd, HZtrF, iwALgj, MxgNt, vXrrP, Ezbs, vON, xfWpVW, BNwdca, xZT, ywRKab, nIvgq, YKlkJu, tYvhk, PKaY, fivX, YAz, WBFbQr, zQEqZY, SAozIe, mldw, gBaVZ, xdQa, MubNd, xtG, JxOKg, mlfD, dkSjDs, tlNzQN, DrorH, NxLbe, XHtldc, vvCNJN, HxkD, aYfO, FvZuF, qzrDy, mSs, rFHH, ljgV, tImgyV, Anmk, TVLA, jzCLFb,