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Kim SE, Hwang S, Lee JH, Gimm G, Han HS, Choi BS, Ro DH. Minimal impact of beam projection angle deviations in skyline (Laurin) view and the efficacy of the anterior border of proximal tibia as a guiding landmark. Skeletal Radiol 2024; 53:1399-1406. [PMID: 38351409 PMCID: PMC11093838 DOI: 10.1007/s00256-024-04619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Obtaining an optimal knee skyline view is challenging due to inaccuracies in beam projection angles (BPAs) and soft tissue obscuring bony landmarks. This study aimed to assess the impact of BPA deviations on patellofemoral index measurements and assessed the anterior border of the proximal tibia as an anatomic landmark for guiding BPAs. MATERIALS AND METHODS This retrospective study consisted of three parts. The first was a simulation study using 52 CT scans of knees with a 20° flexion contracture to replicate the skyline (Laurin) view. Digitally reconstructed radiographs simulated neutral, 5° downward, and 5° upward tilt BPAs. Five patellofemoral indices (sulcus angle, congruence angle, patellar tilt angle, lateral facet angle, and bisect ratio) were measured and compared. The second part was a proof of concept study on 162 knees to examine patellar indices differences across these BPAs. Lastly, the alignment of the anterior border of the proximal tibia with the BPA tangential to the patellar articular surface was tested from the CT scans. RESULTS No significant differences in patellofemoral indices were found across various BPAs in both the simulation and proof of concept studies (all p > 0.05). The angle between the anterior border of the proximal tibia and the patellar articular surface was 1.5 ± 5.3°, a statistically significant (p = 0.037) yet clinically acceptable deviation. CONCLUSION Patellofemoral indices in skyline view remained consistent regardless of BPA deviations. The anterior border of the proximal tibia proved to be an effective landmark for accurate beam projection.
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Affiliation(s)
- Sung Eun Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Sunghyun Hwang
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
| | - Ji Han Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
| | - Geunwu Gimm
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung Sun Choi
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
- CONNECTEVE Co., Ltd, Seoul, South Korea.
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Genestoux V, Vermorel PH, Neri T, Farizon F, Philippot R. Does inverse kinematic alignment coupled with robot-assisted TKA optimize patellofemoral clinical and radiological results? Orthop Traumatol Surg Res 2024:103880. [PMID: 38582224 DOI: 10.1016/j.otsr.2024.103880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION With a satisfaction rate of 80%, total knee arthroplasty (TKA) surgery has seen significant improvements in recent decades. The 20% of poor results may be explained by the alignment technique used for implant placement, which can influence patellofemoral kinematics. The objective of this study was to demonstrate that the use of inverse kinematic alignment makes it possible to obtain satisfactory clinical and radiological patellar scores in robotic TKA. HYPOTHESIS The inverse kinematic alignment technique coupled with robotic surgery makes it possible to restore the native kinematics of the patella. MATERIALS AND METHODS This prospective study including 100 TKAs with a primary TKA performed using the Stryker Mako™ robotic surgery system, and the inverse kinematic alignment technique. Patients who underwent patella resurfacing were excluded. Clinical and radiological scores were recorded preoperatively and 1 year postoperatively. RESULTS At one year, the specific patellar clinical scores were excellent with an average Kujala score of 85.69 and an average HSS Patellar score 88.15. The average patellar lateralization index was 0.15 and the average patellar tilt was 5.1°, showing no significant difference compared to preoperation (p=0.45 and p=0.18). The average external rotation of the femoral implant was 0.47±0.6° [-1.9; 2.1]. DISCUSSION The patellofemoral clinical results were excellent. The use of the robotic arm coupled with this alignment technique makes it possible to obtain a controlled external rotation of the femoral implant as well as an optimized orientation of the tibial component, favoring good restitution of the alignment of the extensor apparatus. This study did not demonstrate any radiological correction of patellar tilt and lateralization. CONCLUSION The combined use of robotic surgery with the inverse kinematic alignment technique seems effective on specific clinical results of the patellofemoral joint. LEVEL OF EVIDENCE II; prospective cohort.
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Affiliation(s)
| | | | - Thomas Neri
- CHU Nord Saint-Étienne, Saint-Priest-en-Jarez, France
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Park KT, Nam TS, Son DW, Lee JK, Ahn JH. The Impact of Patellar Position on Mediolateral Joint Gap in Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Prospective Study. J Arthroplasty 2024; 39:884-890. [PMID: 37858710 DOI: 10.1016/j.arth.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND This prospective study aimed to investigate the influence of patellar position (ie, eversion, lateralization, and reduction) on medial and lateral gap measurements during total knee arthroplasty (TKA) in both cruciate-retaining (CR) and posterior-stabilized (PS) TKA designs. METHODS The present work analyzed 50 knees with primary osteoarthritis that underwent TKA between July and November 2019. Medial and lateral gaps were measured at different knee flexion angles (0°, 45°, 90°, and 120°) in 3 patellar positions after sequentially inserting CR type and PS type trial component in the same knee. RESULTS In CR TKA, medial gaps in patellar reduction showed significantly smaller gaps at 90° and 120° of knee flexion compared to those in eversion and lateralization (P < .001). Lateral gaps in patellar reduction were also significantly larger than those in eversion and lateralization (P < .001). The mediolateral gap difference in patellar reduction was significantly greater at all flexion angles compared to those in eversion and lateralization (P < .001). In PS TKA, similar patterns were observed for medial gaps, lateral gaps, and mediolateral gap differences (P < .001). CONCLUSIONS The ligament balancing with the patella everted or subluxed may lead to an overly tight medial gap and/or loose lateral gap in the knee with a closed arthrotomy, which has potential consequences for knee function in both CR and PS TKA designs. The results of this study highlight the importance of considering patellar position to ensure optimal soft-tissue balance and joint stability in TKA.
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Affiliation(s)
- Ki Tae Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Seok Nam
- Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Dong Wook Son
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Kwang Lee
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Ahn
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Song SJ, Park CH, Lee JW, Lee HW, Kim KI, Bae DK. Infection and Instability Increasing the Risk of Patella Baja and Pseudo-Patella Baja after Revision Total Knee Arthroplasty. Clin Orthop Surg 2023; 15:71-81. [PMID: 36778990 PMCID: PMC9880515 DOI: 10.4055/cios21154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/06/2022] Open
Abstract
Background Patella baja with patellar tendon shortening due to traumatic or ischemic injury is a widely known complication after primary total knee arthroplasty (TKA). Pseudo-patella baja may arise from the elevation of the joint line after excessive distal femoral resection. The maintenance of original patellar height is important in revision TKA because postoperative patella baja and pseudo-patella baja can cause inferior biomechanical and clinical results. We investigated the incidence and risk factors of patella baja and pseudo-patella baja after revision TKA. Methods We retrospectively reviewed data for 180 revision TKAs. Patella baja was defined as a truly low-lying patella with an Insall-Salvati ratio (ISR) of < 0.8 and a Blackburne-Peel ratio (BPR) of < 0.54. Pseudo-patella baja was defined as a relatively low-lying patella compared to the joint line within the normal range of ISR and with a BPR of < 0.54. Clinically, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. Risk factors increasing the incidence of patella baja and pseudo-patella baja after revision TKA were evaluated using multiple regression analysis. Results Before revision TKA, 169 knees did not exhibit patella baja or pseudo-patella baja, while 9 knees showed patella baja and 2 knees exhibited pseudo-patella baja. At 2 years after revision TKAs, 25 knees (13.9%) showed patella baja and 23 knees (12.8%) exhibited pseudo-patella baja. Despite no differences in the postoperative WOMAC score between groups with and without patella baja and pseudo-patella baja, the postoperative ROM was significantly smaller in the group with patella baja (113.3°) or pseudo patella baja (110.5°) than in the normal group (122.0°). Infection as the cause of revision TKA increased the risk of patella baja (odds ratio, 10.958; p < 0.001), and instability increased the risk of pseudo-patella baja (odds ratio, 11.480; p < 0.001). Conclusions Infection and instability resulted in increases in the incidence of patella baja and pseudo-patella baja after revision TKA. Information about the risk factors of patella baja and pseudo-patella baja will help TKA surgeons plan the height of the patella after revision TKA and improve clinical outcomes.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jong Whan Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kand Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
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Sohn S, Koh IJ, Kim MS, Choi KY, Lim DS, In Y. Mobile-Bearing has no Benefit Over Fixed-Bearing Total Knee Arthroplasty in Joint Awareness and Crepitus: A Randomized Controlled Trial. J Arthroplasty 2023; 38:78-84. [PMID: 35934188 DOI: 10.1016/j.arth.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Given higher component conformity, rotational availability of polyethylene insert, and more physiologic patellofemoral tracking, mobile-bearing (MB) total knee arthroplasty (TKA) is supposed to offer advantages in joint perception and crepitus. The purpose of this study was to investigate whether MB TKA offers superior outcomes over fixed-bearing (FB) TKA in terms of joint awareness and crepitus. METHODS This prospective, randomized, controlled trial included 49 FB and 49 MB TKAs that shared the same posterior-stabilized femoral component. Primary outcomes included joint awareness assessed with the Forgotten Joint Score and crepitus graded according to severity and sound at 3 years postoperatively. Secondary outcomes were the range of motion, the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, component position, and joint line level on radiographs. RESULTS The Forgotten Joint Score showed no significant difference between the FB (67 points; range, 0-100) and MB groups (63 points; range, 13-100) (P = .440). For crepitus, no significant differences were found in the overall incidence rate (FB group, 18%; MB group, 12%; P = .386) and grade (grade 1, 6 versus 5; grade 2, 2 versus 1; grade 3, 1 versus 0, respectively). There were no significant differences in range of motion, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index, as well as radiographic outcomes between the two groups (all, P > .05). CONCLUSION MB TKA offers no benefits in terms of joint awareness and crepitus compared with FB TKA at mean 3 years postoperatively. The theoretical advantages of MB TKA have yet to be demonstrated in practice, leaving the selection of bearing type to the surgeon's judgment. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Da Sol Lim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Choi KY, In Y, Kim MS, Sohn S, Koh IJ. Is the patient aware of the difference between resurfaced and nonresurfaced patella after bilateral total knee arthroplasty? A systematic review of simultaneous bilateral randomized trials. Knee Surg Relat Res 2022; 34:4. [PMID: 35164884 PMCID: PMC8842956 DOI: 10.1186/s43019-022-00133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose The optimal practice of patellar management in total knee arthroplasty (TKA) remains controversial. This systematic review was conducted to compare patella-related (1) patient-reported outcome measures (PROMs), (2) clinical outcomes, and (3) reoperation rates after TKA with patellar resurfacing (PR) and nonresurfacing (NPR) in single patients undergoing bilateral patellar procedures during simultaneous bilateral TKA. Methods This review included prospective bilateral randomized trials investigating patella-related PROMs, clinical outcomes, and reoperation (secondary resurfacing and patellar component revision) and other patella-related complications in single patients undergoing randomly assigned PR and NPR during bilateral TKA. Results Six studies were included. There was no difference in PROMs between PR and NPR in five studies, whereas PR was found to be superior to NPR in one study. Five studies reported similar functional outcomes and complication rates between PR and NPR, while one study found better clinical outcomes and a lower complication rate in PR. Between-group secondary resurfacing and patellar revision rates were similar in all studies. Conclusions The majority of patients who underwent bilateral patellar procedures could not tell the difference between PR and NPR following bilateral TKA. There were no differences in clinical outcomes or reoperation and complication rates between PR and NPR. No evidence was found to support routine PR. Level of evidence: Therapeutic Level 1
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Magnetic Resonance Imaging of Patellofemoral Morphometry Reveals Age and Gender Variations in the Knees of Children and Adolescents. Diagnostics (Basel) 2021; 11:diagnostics11111985. [PMID: 34829334 PMCID: PMC8618599 DOI: 10.3390/diagnostics11111985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The morphology and alignment of the patellofemoral joint are crucial risk factors for patellar instability, and the incidence of acute primary patellar dislocation is the highest in women in their second decade of life. The purpose of the study was to analyze age and gender variations of the patellofemoral joint using magnetic resonance imaging (MRI). Methods: A total of 852 patients aged between 4 and 18 years with a history of knee MRI examinations were screened for eligibility and 663 patients (470 males, 193 females) were included. Patients were divided into groups according to age and sex. The age group was divided into five groups (Group 1, 4–6 years; Group 2, 7–9 years; Group 3, 10–12 years; Group 4, 13–15 years; and Group 5, 16–18 years). Three orthopaedic surgeons measured MRI parameters reflecting the patellofemoral morphology (sulcus angle, lateral trochlear inclination, trochlear facet symmetry, and femoral depth) and alignment (tibial tuberosity–trochlear groove distance, percent sulcus location, and percent tibia tuberosity location). Results: Parameters including tibial tuberosity–trochlear groove distance, sulcus angle, percent tibial tuberosity location, trochlear facet symmetry, and femoral depth showed significant differences between the age groups (p < 0.05). The sulcus angle decreased fin Group 2, and the femoral depth showed an increasing trend with aging in male patients. However, the sulcus angle in females decreased first and then increased in Group 3 as the inflection point. The femoral depth showed an opposite pattern. Conclusions: Patellofemoral morphometry showed age and gender variation. Notably, the sulcus angle and femoral depth were significantly different between males and females and changed according to the development. These findings may reflect the sex difference and peak incidence of the patellar instability risk. Understanding the morphological changes and differences of the patellofemoral joint may facilitate the diagnosis of patellofemoral pathologies.
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Noh JH, Kim NY, Song KI. Intraoperative patellar maltracking and postoperative radiographic patellar malalignment were more frequent in cases of complete medial collateral ligament release in cruciate-retaining total knee arthroplasty. Knee Surg Relat Res 2021; 33:9. [PMID: 33743836 PMCID: PMC7981897 DOI: 10.1186/s43019-021-00091-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patellar maltracking after total knee arthroplasty (TKA) can lead to significant patellofemoral complications such as anterior knee pain, increased component wear, and a higher risk of component loosening, patellar fracture, and instability. This study was to investigate the preoperative and operative variables that significantly affect patellar tracking after cruciate-retaining TKA. METHODS We studied 142 knee joints in patients who had undergone TKA: the knees were dichotomized based on postoperative patellar tracking, which was evaluated on patellar skyline, axial-projection radiographs: group 1, normal patellar tracking (lateral tilt ≤ 10° and displacement ≤ 3 mm) and group 2, patellar maltracking (lateral tilt > 10° or displacement > 3 mm). The patients' demographic data and clinical and radiographic measurements obtained before and after surgery were compared between the two groups. RESULTS Preoperative lateral patellar displacement was greater (4.1 ± 2.6 mm vs. 6.0 ± 3.5 mm), as was the frequency of medial collateral ligament (MCL) release (3/67 vs. 24/75) in group 2 than in group 1 (p < 0.001 and p < 0.001, respectively). The distal femur was cut in a greater degree of valgus in group 1 than in group 2. (6.3 ± 0.8° vs. 6.0 ± 0.8°) (p = 0.034). CONCLUSIONS Complete release of the MCL during surgery was associated with patellar maltracking (logistic regression: p = 0.005, odds ratio = 20.592). Surgeons should attend to patellar tracking during surgery in medially tight knees. LEVEL OF EVIDENCE Retrospective comparative study, level III.
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Affiliation(s)
- Jung Ho Noh
- Department of Orthopaedic Surgery, Kangwon National University School of Medicine, 1 Gangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, South Korea.
| | - Nam Yeop Kim
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon-si, South Korea
| | - Ki Ill Song
- Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon-si, South Korea
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