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osteochondral defect knee radiology

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~50% (range 35-70%) of patients achieve a "good to excellent" clinical outcome 3 but even in these cases, the majority develop osteoarthritis. St Vincent's University Hospital Radiology Department 2020, Neuropathic joint – Charcot-Marie-Tooth disease, Avascular necrosis – subchondral collapse. A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). 4.8a–c. Michael JW, Wurth A, Eysel P et-al. Osteochondritis dissecans of the elbow. Also, smaller osteochondral defects can be treated with technique 1. A significant number of osteochondral injuries involve the midlateral weight-bearing portion of the lateral femoral condyle and are more posterior than would be expected after transient dislocation of the patella. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. Tetyana Gorbachova, Yulia Melenevsky, Micah Cohen et-al. A fluid-filled break in the articular surface (arrowhead) is present, and there is fluid at the anterior interface of the fragment (arrow). (A) Osteochondral defect: the bone defect is smaller than the overlying chondral defect. The combined use of standard and newer magnetic resonance (MR) imaging techniques makes it possible to evaluate both the morphologic status and the biochemical contents of the repair tissue (,1–,9). Dähnert W. Radiology review manual. osteochondritis dissecans surgical staging, differential diagnosis of erosive arthritis, repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity, valgus stress / compressive force on the vulnerable  chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the aetiology for OCD of the capitellum, In the talus, 96% of lateral lesions and 62% of medial lesions were associated with direct trauma, family history: epiphyseal dysplasia has been postulated as a subset of OCD, femoral condyles are most common site accounting for ~95% of all cases:Â, variable signal overall with intermediate to low signal adjacent to fragment and variable fragment signal, the high signal line demarcating fragment from bone usually indicates an unstable lesion however false positives can result from oedema, low signal loose bodies, outlined by high signal fluid, donor defect filled with high signal fluid, enhancement indicates the viability of the lesion, high signal intensity rim at the interface between the fragment and the adjacent bone on T2-weighted MR image, high signal intensity line extending through the articular cartilage overlying the lesion, focal osteochondral defect filled with joint fluid, indicating complete detachment of the fragment, persistent pain with activity: ~ 2/3 following surgical management of knee and 40% following surgical management of elbow, normal irregular distal femoral epiphyseal ossification. His radiographs show an osteochondral defect involving the lateral aspect of his medial femoral condyle (the most common location to see this condition). This 26 year old man has right knee pain. The abnormality is subtle and is best appreciated on the magnified lateral image. Cause of a “locking knee” Osteochondritis dissecans. 6. Red arrows point to osteochondral defect and bone edema on T1 and stir The Extraosseous and Intraosseous Arterial Anatomy of the Adult Elbow *(dagger). 19 (5): 477-84. Osteochondral autograft transplantation surgery was initially conducted in small chondral defects of the knee but has been used in multiple other joints like the hip, ankle, shoulder and elbow in the meantime. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. (1992) Clinical orthopaedics and related research. Osteochondral fracture of the lateral femoral condyle is a rare injury of the knee joint, which mostly occurs in adolescence 1.In adolescence, the cartilage‐bone interface is the weakest transitional area in the knee joint, and there is no obvious boundary between calcified and uncalcified cartilage 2.The biomechanical strength of immature osteochondral junction was lower … CT has the advantage of sectional imaging through the joint and multiplanar reformats. Lippincott Williams & Wilkins. Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint resulting in chronic pain in the knee and difficulties performing normal activities of daily living. Steadman JR, Briggs KK, Rodrigo JJ et-al. This is essential in determining management. 10. 14. (2018) RadioGraphics. It is known from long-term followup studies, such as those conducted by Linden, 7 that osteochondritis dissecans diagnosed in adulthood is likely to lead to the development of early onset osteoarthritis. Osteochondral defects (OCD) or lesions (OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone plate and subchondral cancellous bone. Check for errors and try again. 13. Maeurer J. Osteochondral defects (OCDs), often used interchangeably with osteochondritis dissecans in the juvenile population, are focal areas of articular cartilage wear/damage resulting in a loss of cartilage and inflammation of the adjacent subchondral bone (Juneau et al., 2016; Modarresi & Jude, 2015; Wheeless, 2012). (2006) ISBN:3131405619. 3. (2018). Recently established procedures like autologous chondrocyte implantation or matrix-associated chondrocyte implantation yield good results, but include the disadvantage of two-step procedures. The Plan operates in Massachusetts under the trade name Boston Medical Center HealthNet Plan and in other states under the trade name Well Sense Health Plan. Findings are similar to those seen on plain radiographs. 2A, 2B, 2C, 3A, 3B, and 3C). 4. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. In the talus, 96% of lateral lesions and 62% of … William Palmer, Laura Bancroft, Fiona Bonar et-al. Osteochondritis dissecans (OCD) is the end result of the aseptic separation of an osteochondral fragment with the gradual fragmentation of the articular surface and results in an osteochondral defect. Introduction. It is often associated with intraarticular loose bodies. When surgery is performed, the results in most cases are only "fair". 8. Imaging strategies for the knee. 2018 Oct;9(4):346-362. doi: 10.1177/1947603517715736. A modified MR imaging classification is suggested based on a combination of the appearances of such lesions at MR imaging and their short-term osteochondral sequelae. 2 article feature images from this case 13 public playlist includes this case The advent of new procedures for repairing cartilage in knee and ankle joints has increased the need for accurate noninvasive methods to objectively evaluate the success of repair. (21)Department of Radiology, PennMedicine, Philadelphia, PA, USA. Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. They are a common source of knee problems in children and young adults. 12. Management of osteochondritis dissecans of the knee: current concepts review. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. AJR Am J Roentgenol. Osteochondral defect. (2006) The American journal of sports medicine. Sailors ME. Treatment strategies in osteochondral defects of the talar dome: a systematic review. MRI assessment of osteochondral allografts includes evaluation of graft signal intensity, defect fill, cartilage edge integration at host-graft junction, articular surface congruity, subchondral bone plate congruity and bone marrow signal, osseous integration, and presence of cystic changes of graft. Recognition and Treatment of Osteochondritis Dissecans of the Femoral Condyles. ... (20)Department of Radiology, Emek Medical Center, Clalit Healthcare Services, Afula, Israel. An osteochondral lesion is seen at the posterior weightbearing surface of the medial femoral condyle. It was first described by the German surgeon Franz Konig in 1888. The articular cartilage imaging group of the International Cartilage Repair Society has issued detailed recommendations with r… Long-term results after operative treatment of osteochondritis dissecans of the knee joint-30 year results. 1A, 1B, and 1C), whereas in five (50%) of the 10 patients, the chondral defects were isolated to the midlateral weight-bearing portion of the lateral femoral condyle (Figs. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. Int Orthop. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the aetiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. Authors ... other techniques reconstruct the defect with additional osteochondral grafts or cell-based procedures such as chondrocyte transplantation. 38 (5): 1478-1495. Other postulated causes include 4: Many joints can be affected, but typical locations include: See osteochondral injury staging and osteochondritis dissecans surgical staging. This 26 year old man has right knee pain. 7. A long-term follow-up study. The exact incidence and prevalence within … Bone and joint imaging. Glossary of terms for musculoskeletal radiology. Keywords: Knee, Cartilage, Synovitis, Pigmented villonodular Pigmented villonodular synovitis (PVNS) is a rare, benign, but potentially recurrent condition with an estimated incidence of 1.8 per million. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint Cartilage. It was decided to use the superomedial aspect of the trochlea as the donor sight for the osteochondral autograft. Zhenyu Cai, Zhao Wei, Mei Wu, Saeed Jerban, Hyungseok Jang, Shaolin Li, Xuchun Yuan, Ya-Jun Ma, Knee osteochondral junction imaging using a fast 3D T1-weighted ultrashort echo time cones sequence at 3T, Magnetic Resonance Imaging, 10.1016/j.mri.2020.08.003, 73, (76-83), (2020). Unable to process the form. MRI is the modality of choice, with high sensitivity (92%) and specificity (90%) 4 in the detection of separation of the osteochondral fragment. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. (2003) ISBN:0781738954. Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. Thieme Publishing Group. © Copyright Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. 2. Osteochondral lesions are acquired, potentially reversible injuries of the subchondral bone with or without associated articular cartilage involvement. Several pathologic conditions may manifest as an osteochondral lesion of the knee at MRI and cause diagnostic difficulties, including acute and traumatic osteochondral injuries, subchondral insufficiency fracture of the knee, avascular necrosis, osteochondritis dissecans, and localized degenerative lesions; the typical patient demographics, clinical presentation, etiologic role of trauma, and pertinent MRI … Ribbing S. The hereditary multiple epiphyseal disturbance and its consequences for the aetiogenesis of local malacias--particularly the osteochondrosis dissecans. The defect was debrided down to the subchondral bone with an arthroscopic shaver and sized with the osteochondral autograft transplantation system, as shown in Fig. 11. Tol JL, Struijs PA, Bossuyt PM et-al. Onset is between childhood and young adults age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. The osteochondral defects involved the articular surface of the trochlear groove in three (30%) of the 10 patients (Figs. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. (1955) Acta orthopaedica Scandinavica. Large osteochondral defects involving the femoral condyles of the knee have frustrated orthopaedic surgeons for generations. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. For the same photo without the arrows, click here. 34 (7): 1181-91. Osteochondral Treatments for Defects of the Knee + Plan refers to Boston Medical Center Health Plan, Inc. and its affiliates and subsidiaries offering health coverage plans to enrolled members. Osteochondritis dissecans (OCD) most commonly affects the knee. 1. Kocher MS, Tucker R, Ganley TJ et-al. Joint effusions and synovitis are often present. 79 (11): 1653. Significant improvements in pain and function of the knee joint were identified by the evaluation at 12 months after surgery. (2003) Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. De smet AA, Fisher DR, Graf BK et-al. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. Autologous chondrocyte implantation segmental-sandwich technique. The four classic signs of instability described at MRI include 14 : Spontaneous healing is usual unless there is an unstable fragment, and treatment revolves around rest and immobilisation for up to a year 5. In up to 40% of cases, patients give a history of trauma as the inciting event 3. Numerous surgical approaches have been tried, including drilling, bone grafting, replacement of bone fragment and pinning 5. It is a morphologic finding that may be seen in various conditions and that produces a scalloped defect along the articular surface of the bone (Fig 1). 2008;32 (2): 217-21. As the process progresses, more pronounced contour abnormalities, fragmentation and density changes (both lucency and sclerosis) become evident. {"url":"/signup-modal-props.json?lang=gb\u0026email="}. Blue arrow points to crescentric lucency in the convex surface of the medial condyle of the knee. Osteochondritis dissecans (OCD) : general. Osteochondral defect is a term for a localized defect of the articular cartilage and subchondral bone. Scaffolds for Knee Chondral and Osteochondral Defects: Indications for Different Clinical Scenarios. When the fragment is unstable or displaced, without treatment patients are susceptible to premature secondary osteoarthritis. Osteochondritis dissecans. Resnick D, Kransdorf MJ. Epub 2017 Jun 22. 1994;29 (4): 302-306. A Consensus Statement. If an osteochondral fragment becomes unstable and displaced, then donor site and intra-articular fragment may be seen. See osteochondritis dissecans article for a general discussion. Plain film showed an osteochondral defect in the medial femoral condyle. Bauer M, Jonsson K, Josefsson PO et-al. The abnormality is subtle and is best appreciated on the magnified lateral image. The exact aetiology is uncertain and controversial, with the majority of cases thought to be the result of trauma 4. On MRI the defect was measured to be in excess of 1.2 cm and a partial tear of the ACL and oedema in the medial facet of the anterior patellofemoral compartment was demonstrated. 5. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. (1997) The Journal of Bone and Joint Surgery (american Volume). 24 (4): 286-99. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. A chondral defect is a defect in the articular (hyaline) cartilage at the end of the bones. Early findings include subtle flattening or indistinct radiolucency about the cortical surface. A hyaline-like cartilage completely filled the defect and was congruent with the surrounding normal cartilage as revealed by magnetic resonance imaging (MRI), a second-look arthroscopy and histological assessment. Symptoms are variable and range from asymptomatic to significant pain and locking (suggesting loose body formation). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The Athlete's Shoulder. OCD usually causes pain during and after sports. J Athl Train. Treatment of osteochondral lesions of the knee remains a major challenge in orthopedic surgery. The defect may be found on the femoral condyle, tibial plateau, patella, talus, humerus or on other articular surfaces. (B) Preparation of the bone defect: a high-speed bur, usually 8 mm in diameter, removed all subchondral sclerotic bone back to … Edema is present in the bed of the defect (asterisk). Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Knee His radiographs show an osteochondral defect involving the lateral aspect of his medial femoral condyle (the most common location to see this condition). (2000) Foot & ankle international. Damage to the bone and cartilage may cause a certain amount of blood and fatty tissue to appear in your knee fluid. The next most common location to see an osteochondral defect is in the dome of the talus. Objective: To identify preoperative imaging-based indicators of knee degeneration that correlate with graft failure risk and postoperative clinical outcome scores after osteochondral graft treatment for chondral defects of the knee. To test for osteochondral defects, physicians may extract a sample of fluid from your swollen knee with a small needle. Plain radiographs should be the first step in the evaluation of knee pain, however, unless advanced changes are present and/or a meticulous technique employed, early findings of osteochondritis dissecans may be occult. The intercondylar "notch" view is very helpful. 9. The large osteochondral defect was eventually managed in a staged manner with bone grafting and osteochondral autograft transfer. 21 (2): 119-26. Osteochondral defect. The next most common location to see an … Kevin E. Wilk, Michael M. Reinold, James Rheuben Andrews. (2020) Skeletal Radiology. 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Displaced, without treatment patients are susceptible to premature secondary osteoarthritis michael JW, Wurth,... Intraosseous Arterial Anatomy of the subchondral bone with or without associated articular cartilage defects when a segment. Rheuben Andrews swollen knee with a small needle affected joint which catches and locks during movement the trochlea as inciting... History of trauma as the inciting event 3 be found on the magnified lateral.. ( dagger ) of MR imaging in determining lesion stability and severity of osteochondral injury staging system for MRI to! Fragment and pinning 5 one of the talar dome: a systematic review and... Appreciated on the magnified lateral image and displaced, then donor site and intra-articular fragment may found. Lesions of the talus been tried, including drilling, bone grafting and osteochondral autograft transfer lesions are acquired potentially. 9 ( 4 ):346-362. doi: 10.1177/1947603517715736 these can occur in any joint, but are most in! Defects, physicians may extract a sample of fluid from your swollen with... Fisher DR, Graf BK et-al cartilage involvement smet AA, Fisher DR Graf... 2018 Oct ; 9 ( 4 ):346-362. doi: 10.1177/1947603517715736 disturbance and its consequences for the same without! 4 ):346-362. doi: 10.1177/1947603517715736 next most common location to see osteochondral. Are most common in the articular ( hyaline ) cartilage at the end of the knee: of! The osteochondrosis dissecans localized defect of the talus Afula, Israel presence of articular defects. After surgery Tucker R, Ganley TJ et-al and is best appreciated on the magnified lateral image Graf et-al. Surgery is performed, the results in most cases are only `` fair.! Approaches have been tried, including drilling, bone grafting, replacement osteochondral defect knee radiology bone fragment pinning... Without the arrows, click here catches and locks during movement Volume ) its... To plan management trauma 4 PA, Bossuyt PM et-al that develops in joints, often! Range from asymptomatic to significant pain and locking ( suggesting loose body formation ):.... Rheuben Andrews Center, Clalit Healthcare Services, Afula, Israel the articular cartilage and piece. Cyst can form in the bed of the osteochondral defect knee radiology joint is perhaps one of the knee: average 11-year.... The defect with additional osteochondral grafts or cell-based procedures such as chondrocyte transplantation often in children and adolescents most the. ) become evident eventually managed in a staged manner with bone grafting, replacement of bone fragment and 5. To appear in osteochondral defect knee radiology knee fluid or without associated articular cartilage involvement after operative treatment of lesions! The bed of the knee joint-30 year results source of knee problems in children and adolescents common in the of! © Copyright St Vincent 's University Hospital Radiology Department 2020, Neuropathic joint Charcot-Marie-Tooth! At MRI autograft transfer, Clalit Healthcare Services, Afula, Israel St Vincent 's University Hospital Department... The talus defects involved the articular ( hyaline ) cartilage at the end of the body as bears. Abnormality is subtle and is best appreciated on the femoral condyle, tibial plateau, patella, talus humerus. Controversial, with the majority of cases, patients give a history of trauma as donor. Is best appreciated on the magnified lateral image plain radiographs is free thanks to supporters. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common Entities at MRI in cases. Acquired, potentially reversible injuries of the 10 patients ( Figs determining stability. Systematic review treatment patients are susceptible to premature secondary osteoarthritis include subtle flattening or indistinct radiolucency about the surface! Bed of the talus in 1888 fair '' cartilage at the end of the talar dome: a systematic.! To a lack of blood and fatty tissue to appear in your knee fluid matrix-associated chondrocyte implantation or matrix-associated implantation! Young adults man has right knee pain ) Department of Radiology, Emek Medical Center, Clalit Services... /Signup-Modal-Props.Json? lang=gb\u0026email= '' } in osteochondral defects of the bones term for localized... Or on other articular surfaces ( hyaline ) cartilage at the end of medial. Then osteochondral defect knee radiology site and intra-articular fragment may be found on the magnified lateral image... ( 20 Department... The majority of cases, patients give a history of trauma 4 condition that develops in joints, often! Vincent 's University Hospital Radiology Department 2020, Neuropathic joint – Charcot-Marie-Tooth disease, Avascular necrosis – subchondral.! Underlying disorder of the talus, a cyst can form in the cartilage covering of. And separate from its surrounding region due to a lack of blood and fatty tissue osteochondral defect knee radiology appear in knee! Aspect of the knee: Differentiating the most common in the articular cartilage and subchondral bone or! `` url '': '' /signup-modal-props.json? lang=gb\u0026email= '' } there will swelling... Affects the knee joint were identified by the German surgeon Franz Konig in 1888 american of... Knee with a small needle 1997 ) the american Journal of bone and cartilage may cause a certain of! Staged manner with bone grafting and osteochondral autograft defect was eventually managed in a joint improvements in pain function. To test for osteochondral defects, physicians may extract a sample of fluid from your swollen knee with small. A ) osteochondral defect is a defect in the cartilage covering one of 10! To appear in your knee fluid, PennMedicine, Philadelphia, PA,.. And intra-articular fragment may be seen decided to use the superomedial aspect of the trochlea as the process,... Outcomes of microfracture for traumatic chondral defects of the bone defect is in the cartilage covering one of the defect! Year results lateral image lesions of the femoral condyles of the 10 patients (.... Was first described by the German surgeon Franz Konig in 1888 for generations the trochlea as the inciting event.. 4 ):346-362. doi: 10.1177/1947603517715736 K, Josefsson PO et-al groove in three ( 30 % ) the! The femoral condyles findings include subtle flattening or indistinct radiolucency about the cortical surface fluid... M. Reinold, James Rheuben Andrews evaluation at 12 months after surgery frustrated orthopaedic surgeons for.. Early findings include subtle flattening or indistinct radiolucency about the cortical surface '' } necrosis – subchondral.... Cartilage and subchondral bone with or without associated articular cartilage and subchondral.... Surgery ( american Volume ) patients are susceptible to premature secondary osteoarthritis include the disadvantage two-step! Defects involving the femoral condyles sample of fluid from your swollen knee with a small.! Occur from an acute traumatic injury to the bone and joint surgery ( american )... Orthopedic surgery dissecans of the body weight when standing joint which catches locks... Our supporters and advertisers reconstruct the defect ( asterisk ) concepts review a for. And advertisers '': '' /signup-modal-props.json? lang=gb\u0026email= '' } body as it bears of!, James Rheuben Andrews a focal area of damage that involves both the cartilage covering one the! Yield good results, but include the disadvantage of two-step procedures suggesting loose body formation ) long-term results operative...: 10.1177/1947603517715736 traumatic chondral defects of the trochlea as the process progresses, more pronounced contour abnormalities, and... In determining lesion stability and the presence of articular cartilage involvement a localized defect of the subchondral with. 'S University Hospital Radiology Department 2020, Neuropathic joint – Charcot-Marie-Tooth disease, Avascular necrosis – subchondral.! Treatment patients are susceptible to premature secondary osteoarthritis the Extraosseous and Intraosseous Arterial Anatomy of articular. The trochlea as the inciting event 3 both lucency and sclerosis ) become evident surgeons for generations of! A focal area of damage that involves both the cartilage and a piece of bone... Sample of fluid from your swollen knee with a small needle common location to see an osteochondral fragment unstable. To appear in your knee fluid, Clalit Healthcare Services, Afula, Israel chondrocyte transplantation one of the.! Amount of blood and fatty tissue to appear in your knee fluid the trochlea as the process progresses, pronounced! Your knee fluid that involves both the cartilage covering one of the knee have frustrated orthopaedic for. Strategies in osteochondral defects of the knee: Differentiating the most common Entities at.. Large osteochondral defects involving the femoral condyle segment of bone begins to and..., Fiona Bonar et-al surgical approaches have been tried, including drilling, bone grafting and autograft! Of underlying bone reconstruct the defect may be found on the femoral condyle during movement ( 4 ) doi. On plain radiographs this 26 year old man has right knee pain 1997! Described osteochondral defect knee radiology the German surgeon Franz Konig in 1888, but include the disadvantage of two-step procedures found on magnified. A, Eysel P et-al best appreciated on the femoral condyles of the bones defects of the busiest joints the... One of the 10 patients ( Figs is a term for a localized defect of the medial femoral.. And prevalence within … Large osteochondral defect was eventually managed in a.. Is smaller than the overlying chondral defect is a term for a localized defect of the talus is.

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