Isometric Quad Contractions This exercise is also done while seated. Other low-impact exercises can be introduced two months post-surgery or post-injury. Jaberi FM, Abbasi H, Saki N. A modification of tibial inlay fixation in posterior cruciate ligament reconstruction by interference screw: a biomedical study on calf tibial bone model. After week 1, the athlete may be able to maintain aerobic fitness with stationary cycling. In other cases, you may land directly on a bent knee, driving the tibia up and . - Daniel Cooper, MD, 2018 Chicago Sports Medicine Symposium: World Series of Surgery, Contemporary PCL Reconstruction: How I Do It - Michael Ellman, MD (CSMS #68, 2018). A qualified Sports Injury Therapist with a degree in Physical Education, Sports Science and Physics, and a Postgraduate Certificate in Education. i did a LOT of research into knee injuries and surgeries and finally decided to go with a hot shot surgeon-to-the-stars and have my PCL replaced (it was a complete tear). LEARN MORE> PCL Tear: Injury to the posterior cruciate ligament - less common than ACL Injury. As you can see in this study [10] many times PCL injuries occurs because your hamstring muscle fails to effectively do its job, and this is usually caused by overextension or overexertion. A 35-year-old construction worker presents with medial-sided knee pain. If you want to rehabilitate your PCL injury safe using a one to one PCL rehab program under the supervision of the best personal trainer in Londonandknee injury rehabilitation specialistcontact Jazz Alessi now by clicking on this link. The Lancet. Markus Greber. Additional symptoms may include a popping sound at the point of injury, pain and swelling in the affected joint, according to Mayo Clinic. A partial medial collateral ligament tear is an injury to one of the ligaments that support your knee. at risk when drilling the tibial tunnel (increases with knee extension), lies just posterior to PCL insertion on the tibia, separated only by posterior capsule, Patellofemoral and medial sided pain/arthritis, PCL deficiency leads to increased contact pressures in the, Proximal Tibiofibular Joint Ganglion Cysts, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Pre-Participation Physical Exam in Athlete, Concussions (Mild Traumatic Brain Injury). document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Riding a bike, particularly a stationary bike, with a torn ACL provides several benefits that can improve the process of healing. Car Accident: Dashboard injuries, where the knee is bent and the shin hits the car dashboard pushing the knee into hyperflexion is the most common cause of PCL tears Fall: Falling onto a bent knee with the foot pointing downwards is the most common sporting PCL injury Sporting Tackle: sometimes the posterior cruciate ligament can be injured during an awkward tackle when the knee is bent Complete rest for the first 48 hours, after that, let pain be the guide to the speed of progression of rehabilitation. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. The aim here is to get a little bit of elasticity to the healing tissue, not increase flexibility. Strengthening exercises continue with phase 1 exercises and also begin to include standing static quads (instead of sitting), half squats (both legs), hip raises, hip exercises against resistance, step-ups and single-leg calf raises. Posterior Cruciate Ligament Injury Treatment & Management. The knee joint is supported by the quadriceps, the muscle at the front of the thigh, and the hamstrings at the back of the thigh. Aim for 3 sets of 10 to 20 repetitions daily. Young, C, MD. Among the isolated lesions, bone avulsions were nine (10.6%). Start at 50% of maximum speed and increase each session to 90% of maximum speed. This means your lower leg twists more than normal in relation to the upper leg (femur). Anelite personal trainer in Londoncan help you recover from your sports injury fast and safe. The PCL, in particular, keeps the lower leg from moving too far back relative to the upper leg, especially when the knee is bent. Closed chain active terminal extension exercises, Prone passive flexion with active terminal extension. Learn how your comment data is processed. Sometimes, cortisone, hyaluronic acid, or PRP injections are needed. Physical therapists usually recommend the practice of the exercise bike since it is a gentle, smooth, safe and practical sport to do at home. (OBQ11.204) Place the fingers on the muscle towards the inside of the leg above the knee (vastus medialis muscle). The ACL can be injured or torn in a number of different ways. You also have the option to opt-out of these cookies. This guideline is intended to provide the treating clinician a frame of reference for rehabilitation. cortisone, hyaluronic acid, or PRP injections are needed. Common cycling injuries which may occur traumatically due to a collision or fall from the bike include:. Contract the quadriceps muscles and hold for 5 to 10 seconds. Crap, such a low grade endo resulted in some high grade injuries! Generally, on examination, there is looseness in moving the shin bone forwards on the thigh bone also called Lachmans test. More importantly, bike riding is fine.I did 2 full days at Northstar with no problems, XC rides,jumping, 6 foot drops, all with no discomfort. i was definitely able to ride in the interim (in fact it was a big part of my rehab) but the feeling of "looseness" in the knee was pronounced during other activities - running, basketball, etc. 6. You must in any case talk to your physiotherapist about when you can start it and what you can do. A PCL sprain is a tear of the posterior cruciate ligament. This exercise can be progressed later in the rehabilitation process by doing single leg calf raises and then single leg calf raises without leaning against a wall or holding onto anything. A benign sprain is a tear of part of the ligaments, A severe sprain corresponds to a total rupture of the ligaments. A fall while skiing, a football tackle, the knee tilts in and the foot goes outwards, it is the sprain of the knee or what we also call a twisted knee. In most cases, there is a limited range of motion and swelling in the knee. Generally, we start with range of motion exercises and then move to non-weight-bearing and weight-bearing quadriceps and calf exercises. Following a torn ACL, you may enter a rehabilitation program to reduce pain and restore function to your knee. However, knee pain may be a result of many other factors. Hi Lucia, Pedaling at a slower pace may also put more pressure on your knee. The Posterior Cruciate Ligament (PCL) is one of the four major ligaments of the knee joint that functions to stabilize the tibia on the femur. The Pudendal nerve (nerve that causes cyclist syndrome) is a combination of 3 nerves that form a single nerve. (2002) 692-93. Oct 2012. Often the diagnosis can be made on the basis of the physical exam . This extra tension puts massive stress on a ligament not meant to hold force, so the ligament tears. Id try rehab first. 2004. To provide the best experiences, we use technologies like cookies to store and/or access device information. Lance Stroll reveals full extent of injuries after cycling crash, including broken toe. Pain, inflammation the cruciate ligaments of the knee have relaxed or torn and it will be necessary, whether or not there is operation, to immobilize the knee and then undergo rehabilitation! If your knee is still swollen maybe you should take it real easy. Management of Chronic Tibial Subluxation in the Multiple-Ligament Injured Knee. One example is the PCL jack brace. Your doctor will examine your knee to see if the PCL is intact. Mike is creator & CEO of Sportsinjuryclinic.net. Understanding the status of your recovery may help you know what you can and cannot do within yoursports injury rehabilitationstage. This website uses cookies to improve your experience. Does a grade 1 or 2 PCL injury need surgery? A football player sustains an isolated posterior cruciate ligament (PCL) tear. If you are suffering from any illness, disease or ailments please contact your doctor first and immediately. The PCL keeps the shinbone from moving backward too far. This will stretch the large Gastrocnemius muscle which attaches above the knee. If the clinician Pediatric Emergency Care. He has been treated with rest and rehabilitation but is unable to play at his previous level due to his knee "giving way." You must log in or register to reply here. This will gradually introduce them to the demands of competition both physically and psychologically. Sustained rehab over 6-9 months should enable you to get back to full function. Essentials of exercise physiology. Typically, the knee brace pushes the shin bone forward, allowing a torn PCL to heal. Tibial subluxation is a major aggravating PCL risk factor. One of the most common causes of PCL and ACL injuries is experiencing a car accident. Because this cardio-hating gal who has never run in her entire life and hasn't properly ridden a bike since before she had her almost 12-year-old daughter, she loves her Peloton cycle. Lie on your back and bend the knee ensuring the foot stays in contact with the floor. In some cases, the forces on the kneecap or the medial compartment increase leading to early arthritis in these joints. Typically injured in RTA, fall or sports. PCL injuries can also result from a blow to the knee while it is. The posterior cruciate ligament (PCL) is located inside your knee joint and connects the bones of your upper and lower leg. [ 10] Posterior cruciate ligament tears: functional and postoperative rehabilitation. Cycling, only on a stationary bike where control settings can be made, can be initiated as early as four weeks post-surgery or post-injury [3]. You have to take care of yourself, though. Place the fingers on the muscle towards the inside of the leg above the knee (vastus medialis muscle). Sports Medicine, Feb 2014. The key to success is to be constant and to persevere. Over time, you may expect to eventually ride a regular bike again outside once your doctor has given permission, although mountain biking after ACL surgery will have to wait. is the pcl the one that holds in knee cap? McArdle, W, Katch, F, Katch,V. (OBQ09.82) So I just got the word that my little misadventure a few weeks ago has caused a "high grade PCL tear". Expectations and hope, influenced by health professionals, can hugely influence recovery [13]. However, higher grade 2 and grade 3 injuries are often treated with a knee brace to help stiffen the knee. It will get better, don't worry about that. Conceptual framework for strengthening exercises to prevent hamstring strains. Similar to the anterior cruciate ligament, the PCL connects the femur to the tibia. Knee anatomy and knee ligaments PCL, ACL and MCL. It has similar symptoms to patellofemoral pain. They can do this well if given the time to build up with no additonal trauma in the area. According to Harvard Health Publishing, the PCL is most commonly injured during automobile accidents and in sports when athletes fall forward on a bent knee. Most PCL injuries will heal without surgery. Increasing Knee Range of Motion Using a Unique Sustained Method. also swells a little after a long day on my legs, but other than that i have no issues. If instability develops, people report feeling they cant trust the knee or that the knee gives way with specific movements. This knee brace limits movement from 0 to 90 degrees and should only be used in the early stages of rehab. 2011. A knee sprain is a damage of the ligaments in the knee joint. Repeat 10 to 20 times. Ludvigsen, T., Figved, W. and Engebretsen, L., 2010. Make sure to lower the saddle slightly to prevent your leg from tensing too much when pedaling. The technical storage or access that is used exclusively for statistical purposes. WHAT YOU SHOULD KNOW. Grades 1 and 2 sprains are treated non-operatively so long as there as no other damage to the surrounding ligaments or tendons in . Cycling is very good exercise for people with knee pain because of the low-impact pedaling. Progress strength exercises from phase 2 by increasing resistance and moving from double-leg exercises to single-leg exercises. Sometimes, a PCL tear may be subtle, particularly in partial tears producing only minimal pain and swelling. I had a full PCL tear 19 months ago. Following these steps can help you understand the PCL injury mechanism, and also assist with successful PCL injury rehabilitation. The Posterior Cruciate Ligament (PCL) is a paired ligament in the middle of the knee. This set of stretching can be done three times a day more as long as it does not hurt. Isolated PCL injury occurred in (15.3%) cases, and combined (84.7%). Step down . Posterior Cruciate Ligament: Anatomy and Biomechanics. What should you do, what should you avoid? Not consenting or withdrawing consent, may adversely affect certain features and functions. After an injury like this, prioritizing your pain and knowing how to eliminate it is vital. surgery was arthroscopic and over before i knew it. Common conditions responsive to injection treatment: Acromioclavicular joint (AC joint) arthritis, Advanced lavage or barbotage for calcification of tendons, Patellofemoral joint osteoarthritis or anterior knee pain, Gluteus medius tendonitis or trochanteric bursitis, Pain and swelling after an ankle sprain or rolled ankle/ torn lateral ligaments, Os Trigonum: cause of pain at the back of the ankle, Thumb arthritis (1st carpometacarpal joint osteoarthritis), posterior cruciate ligament (PCL) injury accounts for up to 20% of acute knee injuries, doctors recommend a knee brace for six weeks following an injury. 5th ed. Strengthening exercises (pain-free) static quads, static hamstring holds, calf raises (both legs). Knee swelling with ecchymosis, pain, deformity, and instability. Completing injury rehabilitation training can also benefit your individual recovery plan. Most people have heard of an ACL injury suffered commonly by amateur and elite athletes of all ages. Physical exam reveals 10 varus alignment when standing and a varus thrust with walking. Ligamentous exam reveals a stable ACL and MCL, but opens to a varus stress and a 3+ posterior drawer and positive dial test at both 30 and 90 degrees of flexion. The more out of shape you are, the steeper the hill looks. it felt so much better after they had done that. Whether youre a workout junkie or homebody, sports injury rehabilitation programme designed by aPCL personal trainer rehabilitation specialist in Londoncould help you get back to 100%, and stay there. When you purchase through links on our site, we may earn an affiliate commission, which supports our community. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. Sometimes, people hear a pop or a sense of giving way. The PCL crosses the ACL in an "X" shaped pattern. They are cause by either a direct blow (more severe tear) or a non-contact injury (less severe). The technical storage or access that is used exclusively for anonymous statistical purposes. Clinical features. This can be developed to increase range of movement if needed by using a towel or similar to pull on the leg further than it would normally go. 2018;11(3):510-514. doi:10. . Pain under the knee cap is known as runner's knee and can plague cyclists as well. The posterior drawer. Adjust the gears to a low level that allows for a minimum of 90 repetitions per minute in the beginning. Closed-chain strengthening with squats or leg presses can be started as the ligament heals. Begin a gradual return to running. Generally, I dont recommend surgery for isolated grade 1-2 PCL injuries. Copyright 2021 365 moves. One study states that the rehabilitation of the PCL reconstructive or nonsurgical patient is greatly dependent on dynamic quadriceps stability [14]. Ligaments are sturdy bands of tissues that connect bones. Associated injuries. Slight discomfort may be felt but not pain. Generally, for grade 1 and mild grade 2 injuries, simple treatments are started first. A healthy knee joint should flex to 120 [8]. It originates from the anterolateral aspect of the medial femoral condyle in the area of the intercondylar notch and inserts onto the posterior aspect of the tibial plateau. Depending on the extent of the injury, you may need surgery to correct this condition. You must be constant in your efforts and persevere! This is not medical advice. Apr 2015. As a result, it, Posterolateral corner injury causes pain at the back and outside of the knee. The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes. A complete PCL tear occurs when the entire ligament is torn into two pieces. At the time of the injury, a "pop" or "snap . These injuries are relatively uncommon. Generally, these problems settle with good solid rehab. This protocol is intended to provide the user . During the physical exam, your doctor will check your knee for swelling and tenderness comparing your injured knee to your uninjured knee. The aim is to restore strength, balance, and control before restarting running and sports-specific training. Rehab is a key step in the healing process for restoring proper knee coordination and strengthening the muscles that assist and protect the ligaments. Whichever situation you have endured, there are several protocols to follow and many PCL Injury exercises you must avoid in order to have a successful knee rehab recovery. I have been detected with pcl avulsion, what is the best treatment. If you feel that you have done too much, take one or two days off before resuming your rehabilitation exercises or your training. I have a grade 3 PCL tear. ABSOLUTELY! Dr. Masci is a specialist sport doctor in London. VerticalScope Inc., 111 Peter Street, Suite 600, Toronto, Ontario, M5V 2H1, Canada. Keep the heel of the back leg on the ground and gently push forward. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is one of the two cruciate ligaments in the knee (the other being the anterior cruciate ligament or ACL). Remember that the quadriceps muscle is a powerful knee extensor. Pierce CM, OBrien L, Griffin LW. Bicycling also provides range-of-motion exercises to move the knee joint and support the cartilage. Knee Taping for Stability: Meniscus Tear, ACL Strain and Cartilage Amanda RunToTheFinish 16.9K subscribers 1.5M views 5 years ago Watch my second video on how to tape to reduce swelling, which is. Rehabilitation of isolated and combined posterior cruciate ligament injuries. Torn PCL exercises - early strengthening Static quads seated Contract the quadriceps muscles and hold for 5 to 10 seconds. Elbow Ligament Injuries. Gender-specific correlates of complementary and alternative medicine use for knee osteoarthritis. Res. Whether you go with a non-surgical treatment or you need surgery and rehabilitation, you might be limited in your weight-bearing activities. In the case of a rupture of the ligaments (severe sprain), a knee surgery can be considered and the ligament replaced by a tendon graft. They allow the bones to move while fixing limits thanks to their elasticity (and thus avoid the dislocations, that happen when a joint is dislocated). Cycling is arguably a joint-friendly alternative to running, provided you do not fall prey to a common source of sports injuries: training error. He has been writing about fitness and giving workout tips and advice since 2016. PCL injury classification. 5. Place your foot on a table or similar and lean into the stretch, keeping your leg straight and chest up. For me it hurt for about 2 months, but I took it easy and didn't overdo it.You shouldn't be walking on uneven ground right now, just doing excercises specific to your quads, ie cycling on a trainer or riding on a flat surface. Introduction. Therefore, we advise to rehabilitate your knee injury by working closely with a long term personal trainer rehabilitation expert. Riding a bicycle improves circulation to the lower extremities and also works the muscles both above and below the knee, which can improve support for the joint. Skiing injury (the binding on that side pre-released). The path to recovery from significant injury is long and . Simply raising up and down on the toes, keeping the legs straight. This exercise can also be done in a standing position. It is absolutely necessary to immediately consult a doctor in case of sprain! Both the ACL and PCL criss-cross the knee providing support and preventing the knee from moving forwards and backward. Can I Do More Damage Walking on a Torn ACL? Progressive weight bearing is another goal to keep in mind. Glucosamine supplementation after anterior cruciate ligament reconstruction in athletes: a randomized placebo-controlled trial. Know from these PCL Rehabilitation Guidelines. Start slowly with light exercises on your exercise bike with low resistance for 5 to 10 minutes per day. I am in PT, and see my doctor again on Nov. 8th. Posterior Cruciate Ligament Injury Introduction Injury to the posterior cruciate ligament (PCL) can range from a stretch to a total tear or rupture of the ligament. Generally, it would be best to avoid hyperextension and exercises that push the shin bone backward, such as isolated hamstring exercises (prone knee curls). Never force! Sports Med. KnowingPCL rehabilitation guidelinescan be even harder as every injury is different and a large percentage of the PCL injuries have aggravating factors. It is used during treatment and rehabilitation phases, as well as, The aim of taping for a Posterior cruciate ligament injury or torn PCL is to support the knee. The only time my knee hurts now is occaisonally if it twists a little bit, or when I fly ( don't know why though). can ride XC with it no problems. A gentle stretch should be felt at the back of the leg but it should not be painful. Diagnosis can be suspected clinically with a traumatic knee effusion and increased laxity on a posterior drawer test but requires an MRI for confirmation. Exercises that push your shin bone (tibia) in backward direction should be avoided in early weeks. Reginster, J. Deroisy, L. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. When the athlete is confident they should be returned to sport in a limited capacity,for example, a footballer may play only 20 minutes of a game. There are four different grades of classification in which medical doctor's classify a PCL injury: Grade I, the PCL has a slight tear. Recovery following injury hinges upon expectation and hope. Read more: Gym Leg Workouts for ACL Recovery. So what is a Knee PCL tear, and how do we treat it? so riding DH or anything sketchy i wear hte braces, just incase i crash on it. Aims To control swelling, maintain the ability to straighten and bend the leg, and begin strengthening exercises for the leg muscles when possible. It is important that this muscle is developed and this one should be felt contracting whilst performing the exercises. For a better experience, please enable JavaScript in your browser before proceeding. Lippincott Williams & Wilkins. The ortho said grade 2 but its a complete tear. For, as large and complex as it is, your knee joint can easily be injured due to its dependence on surrounding muscles and ligaments for stability. 2012 Oct-Dec. Wilk, KE. Take the stretch as far as is comfortable and hold relaxing into the stretch. Peterson, C. MD, Young, C, MD. PCL injuries are traumatic knee injuries that may lead to posterior knee instability and often present in combination with other ipsilateral ligamentous knee injuries (i.e PLC, ACL). The rehabilitation phase will be followed by a physiotherapist. PCL is the primary restraint to posterior tibial translation, functions to prevent hyperflexion/sliding, isolated injuries cause the greatest instability at 90 of flexion, combined PCL and posterolateral corner (PLC) injuries, posterior tibial sulcus below the articular surface, strongest and most important for posterior stability at 90 of flexion, reciprocal function to the anterolateral bundle, lies between the meniscofemoral ligaments, ligament of Humphrey (anterior) and ligament of Wrisberg (posterior), originate from the posterior horn of the lateral meniscus and insert into PCL substance, minimizes posterior tibial displacement (95%), based on posterior subluxation of tibia relative to femoral condyles with knee, ibia remains anterior to the femoral condyles, complete injury in which the anterior tibia is flush with the femoral condyles, a combined PCL + capsuloligamentous injury, tibia is posterior to the femoral condyles and often indicates an associated ACL and/or PLC injury, differentiate between high- and low-energy trauma, hyperflexion athletic injury with a plantar-flexed foot, ascertain a history of dislocation or neurologic injury, often subtle or asymptomatic in isolated PCL injuries, laxity at 30 alone indicates MCL/LCL injury, patient lies supine with hips and knees flexed to 90, examiner supports ankles and observes for a posterior shift of the tibia as compared to the uninvolved knee, the medial tibial plateau of a normal knee at rest is 10 mm anterior to the medial femoral condyle, an absent or posteriorly-directed tibial step-off indicates a positive sign, with the knee at 90 of flexion, a posteriorly-directed force is applied to the proximal tibia and posterior tibial translation is quantified, isolated PCL injuries translate >10-12 mm in neutral rotation and 6-8 mm in internal rotation, combined ligamentous injuries translate >15 mm in neutral rotation and >10 mm in internal rotation, attempt to extend a knee flexed at 90 to elicit quadriceps contraction, positive if anterior reduction of the tibia occurs relative to the femur, > 10 ER asymmetry at 30 only consistent with isolated PLC injury, KT-1000 and KT-2000 knee ligament arthrometers, used for standardized laxity measurement although less accurate than for ACL, may see avulsion fractures with acute injuries, medial and patellofemoral compartment arthrosis may be present with chronic injuries, apply stress to anterior tibia with the knee flexed to 70, asymmetric posterior tibial displacement indicates PCL injury, contralateral knee differences >12 mm on stress views suggest a combined PCL and PLC injury, confirmatory study for the diagnosis of PCL injury, quadriceps rehabilitation with a focus on knee extensor strengthening, surgery may be indicated with bony avulsions or a young athlete, extension bracing with limited daily ROM exercises, immobilization is followed by quadriceps strengthening, isolated Grade II or III injuries with bony avulsion, isolated chronic PCL injuries with a functionally unstable knee, primary repair of bony avulsion fractures with ORIF, allograft is typically utilized with multiple graft choices available, options include - Achilles, bone-patellar tendon-bone, hamstring, and anterior tibialis, good results achieved with primary repair of bony avulsions, primary repair of midsubstance ruptures are typically not successful, results of PCL reconstruction are less successful than with ACL reconstruction and residual posterior laxity often exists, successful reconstruction depends on addressing concomitant ligament injuries, no outcome studies clearly support one reconstruction technique over the other, consider medial opening wedge osteotomy to treat both varus malalignment and PCL deficiency, when performing a high tibial osteotomy in a PCL deficient knee, increasing the tibial slope helps reduce the posterior sag of the tibia, shifts the tibia anterior relative to the femur preventing posterior tibial translation, posteromedial portal is placed 1 cm proximal to the joint line posterior to the MCL, avoid injury to branches of the saphenous nerve during placement, posteromedial corner of the knee is best visualized with a 70 arthroscope either through the notch (modified Gillquist view) or using a posteromedial portal, transtibial drilling anterior to posterior, fix graft in 90 flexion with an anterior drawer, results in knee biomechanics similar to native knee, biomechanical advantage with a decrease in the "killer turn" with less graft attenuation and failure, screw fixation of the graft bone block is within 20 mm of the popliteal artery, arthroscopic or open techniques may be utilized, biomechanical advantage with knee function in flexion and extension, clinical advantage has yet to be determined, may be advantageous to perform with combined PCL/PLC injuries for better rotational control as PLC reconstructions typically loosen over time, avoid resisted hamstring strengthening exercises (ex.
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