Background: The selection of the type of graft used to reconstruct the anterior cruciate ligament (ACL) remains a matter of debate. In the past, the quadriceps tendon (QT) was associated with considerable morbidity and less favorable outcomes than other grafts. Improvements in harvesting methods have decreased morbidity of the surgical procedure and led to an increase in the use of QT in recent years. Indications: The QT graft with patellar bone block is a viable option for all patients with closed physis undergoing ACL reconstruction. It is especially suitable for young and active patients who practice activities that require kneeling or athletes in which hamstrings preservation is advisable. Technique Description: A vertical mini-invasive longitudinal incision starts 1 cm proximal to the middle of the patellar pole. After dissection, the bone block is marked and detached with an oscillating saw. A drill hole is performed in the bone block to serve for the passage of a traction suture. The bone block is lifted with the help of the traction suture, and the graft is trimmed to the desired diameter. The layer between tendon and capsule is separated by blunt dissection to spare the capsule of the suprapatellar pouch. Harvesting is achieved using a dedicated QT harvester. Usually, a graft length of 8 cm is harvested. The defect in the QT is closed using a suture passer at the proximal end. Finally, the graft is prepared and calibrated according to the planned technique for ACL reconstruction. Results: There was no major intraoperative complication in the senior author's series (more than 50 patients) using the dedicated QT harvester. On rare occasions (<10% of the cases), the device opened the suprapatellar joint capsule, creating the additional need for capsular repair during defect closure. On two occasions, the graft was shorter than expected, which may have been caused by insufficient dissection or improper use of the harvester. Discussion/Conclusion: ACL reconstruction with minimally invasive QT graft harvesting methods has shown very good clinical outcomes with few complications. It can be recommended for primary and revision ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
{"title":"Mini-Invasive Harvesting of Quadriceps Tendon Graft With Patellar Bone Block for ACL Reconstruction Using a Dedicated Harvester","authors":"Giulio Vittone, Jérôme Valcarenghi, Caroline Mouton, Romain Seil","doi":"10.1177/26350254231207405","DOIUrl":"https://doi.org/10.1177/26350254231207405","url":null,"abstract":"Background: The selection of the type of graft used to reconstruct the anterior cruciate ligament (ACL) remains a matter of debate. In the past, the quadriceps tendon (QT) was associated with considerable morbidity and less favorable outcomes than other grafts. Improvements in harvesting methods have decreased morbidity of the surgical procedure and led to an increase in the use of QT in recent years. Indications: The QT graft with patellar bone block is a viable option for all patients with closed physis undergoing ACL reconstruction. It is especially suitable for young and active patients who practice activities that require kneeling or athletes in which hamstrings preservation is advisable. Technique Description: A vertical mini-invasive longitudinal incision starts 1 cm proximal to the middle of the patellar pole. After dissection, the bone block is marked and detached with an oscillating saw. A drill hole is performed in the bone block to serve for the passage of a traction suture. The bone block is lifted with the help of the traction suture, and the graft is trimmed to the desired diameter. The layer between tendon and capsule is separated by blunt dissection to spare the capsule of the suprapatellar pouch. Harvesting is achieved using a dedicated QT harvester. Usually, a graft length of 8 cm is harvested. The defect in the QT is closed using a suture passer at the proximal end. Finally, the graft is prepared and calibrated according to the planned technique for ACL reconstruction. Results: There was no major intraoperative complication in the senior author's series (more than 50 patients) using the dedicated QT harvester. On rare occasions (<10% of the cases), the device opened the suprapatellar joint capsule, creating the additional need for capsular repair during defect closure. On two occasions, the graft was shorter than expected, which may have been caused by insufficient dissection or improper use of the harvester. Discussion/Conclusion: ACL reconstruction with minimally invasive QT graft harvesting methods has shown very good clinical outcomes with few complications. It can be recommended for primary and revision ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.","PeriodicalId":485913,"journal":{"name":"Video journal of sports medicine","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135735308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/26350254231195090
Anna Bartsch, Forrest L. Anderson, Markus Neubauer, Monica S. Vel, Seth L. Sherman
Background: The medial and lateral menisci act as shock absorbers for the knee joint by converting and redistributing axial load into circumferential hoop stresses. Disruptions of these hoop stresses occur in the setting of meniscal deficiency and lead to long-term degenerative changes. Therefore, maintaining the distinctive composition and organization of the menisci is essential. In selective cases of meniscal deficiency, meniscus allograft transplantation can be a valuable treatment option. Indications: Meniscus transplantation should be considered in patients with symptomatic meniscal deficiency, without the presence of advanced degenerative pathologies, who have failed all conservative treatments. Technique description: We can divide the surgery into 4 steps: (1) graft preparation, (2) arthroscopic joint preparation, (3) allograft attachment preparation, and (4) graft fixation. Results: Meniscus allograft transplantation yields good to excellent results in up to 85% of cases. Improvement of pain and knee function occurs in approximately 70% of the patients at 10 years. The associated complications are mainly joint stiffness, early osteoarthritis, and incomplete healing accompanied by graft failure. Graft failure is the most feared complication, yet shows good results over the midterm. Conclusion: The bone plug technique we have shown here is a hybrid approach combining soft tissue and bone fixation techniques. It provides synergistic advantages with good osseous integration and is minimally invasive through arthroscopy without true arthrotomy. In our experience, this approach elegantly eases the complexity of this demanding surgery while yielding excellent results for patients. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
{"title":"Medial Meniscal Allograft Transplantation: The Bone Plug Technique","authors":"Anna Bartsch, Forrest L. Anderson, Markus Neubauer, Monica S. Vel, Seth L. Sherman","doi":"10.1177/26350254231195090","DOIUrl":"https://doi.org/10.1177/26350254231195090","url":null,"abstract":"Background: The medial and lateral menisci act as shock absorbers for the knee joint by converting and redistributing axial load into circumferential hoop stresses. Disruptions of these hoop stresses occur in the setting of meniscal deficiency and lead to long-term degenerative changes. Therefore, maintaining the distinctive composition and organization of the menisci is essential. In selective cases of meniscal deficiency, meniscus allograft transplantation can be a valuable treatment option. Indications: Meniscus transplantation should be considered in patients with symptomatic meniscal deficiency, without the presence of advanced degenerative pathologies, who have failed all conservative treatments. Technique description: We can divide the surgery into 4 steps: (1) graft preparation, (2) arthroscopic joint preparation, (3) allograft attachment preparation, and (4) graft fixation. Results: Meniscus allograft transplantation yields good to excellent results in up to 85% of cases. Improvement of pain and knee function occurs in approximately 70% of the patients at 10 years. The associated complications are mainly joint stiffness, early osteoarthritis, and incomplete healing accompanied by graft failure. Graft failure is the most feared complication, yet shows good results over the midterm. Conclusion: The bone plug technique we have shown here is a hybrid approach combining soft tissue and bone fixation techniques. It provides synergistic advantages with good osseous integration and is minimally invasive through arthroscopy without true arthrotomy. In our experience, this approach elegantly eases the complexity of this demanding surgery while yielding excellent results for patients. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.","PeriodicalId":485913,"journal":{"name":"Video journal of sports medicine","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/26350254231177378
Stefano Zaffagnini, Alberto Grassi, Gian Andrea Lucidi, Giacomo Dal Fabbro, Luca Ambrosini
Background: The anterior cruciate ligament (ACL) is a primary restraint to anteroposterior as well as rotatory knee laxity. In case of concomitant lesion of menisci or other ligamentous structures, further dynamic instability is encountered. A lateral extra-articular tenodesis (LET) augmentation has been proposed by the Authors to treat or prevent residual laxity. Indications: ACL reconstruction is recommended in young athletes involved in pivoting sports, non-contact pivoting injuries, high-grade pivot shift, deep notch sign and double bone bruise, meniscal loss, and revision of previous bone-patellar tendon-bone autograft. Technique Description: A 2 to 3 cm oblique incision is made over the pes anserinus. Gracilis and semitendinosus tendons are harvested with their attachment preserved and sutured together. Tibial tunnel is reamed after positioning of a guide pin. A wire-loop passer is directed from the tibial tunnel to the anteromedial portal. A 2 to 3 cm longitudinal incision is made superior-laterally, the ileotibial band is divided and retracted anteriorly. A suture-loop is retrieved from the lateral incision through the anteromedial portal with a curved Kelly clamp. The suture is placed into the wire-loop and retrieved with it from the tibial tunnel. The graft is retrieved from the lateral incision, tensioned with the knee at 70° to 90° of flexion and foot in neutral rotation and secured with 2 staples to the femur. A 1-cm skin incision is performed just below the Gerdy tubercle. The graft is retrieved from this incision below the fascia with a small Kelly clamp, tensioned and secured with a staple. The iliotibial tract defect is closed. Results: At long-term follow-up, a revision rate of 3% has been reported, while patient-reported outcome measures (PROMs) were excellent. At very-long-term follow-up, most patients were still involved in sports with a very low rate of positive Lachman and pivot shift tests. No overconstraint and lateral osteoarthritis were encountered. Medial osteoarthritis was related only to medial meniscectomy. Discussion/Conclusion: The ACL reconstruction plus LET over-the-top technique is a safe and reliable surgery with a low rate of reoperations and peri-operative complications at very-long-term follow-up. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
{"title":"Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis: The “Over-the-Top” Technique","authors":"Stefano Zaffagnini, Alberto Grassi, Gian Andrea Lucidi, Giacomo Dal Fabbro, Luca Ambrosini","doi":"10.1177/26350254231177378","DOIUrl":"https://doi.org/10.1177/26350254231177378","url":null,"abstract":"Background: The anterior cruciate ligament (ACL) is a primary restraint to anteroposterior as well as rotatory knee laxity. In case of concomitant lesion of menisci or other ligamentous structures, further dynamic instability is encountered. A lateral extra-articular tenodesis (LET) augmentation has been proposed by the Authors to treat or prevent residual laxity. Indications: ACL reconstruction is recommended in young athletes involved in pivoting sports, non-contact pivoting injuries, high-grade pivot shift, deep notch sign and double bone bruise, meniscal loss, and revision of previous bone-patellar tendon-bone autograft. Technique Description: A 2 to 3 cm oblique incision is made over the pes anserinus. Gracilis and semitendinosus tendons are harvested with their attachment preserved and sutured together. Tibial tunnel is reamed after positioning of a guide pin. A wire-loop passer is directed from the tibial tunnel to the anteromedial portal. A 2 to 3 cm longitudinal incision is made superior-laterally, the ileotibial band is divided and retracted anteriorly. A suture-loop is retrieved from the lateral incision through the anteromedial portal with a curved Kelly clamp. The suture is placed into the wire-loop and retrieved with it from the tibial tunnel. The graft is retrieved from the lateral incision, tensioned with the knee at 70° to 90° of flexion and foot in neutral rotation and secured with 2 staples to the femur. A 1-cm skin incision is performed just below the Gerdy tubercle. The graft is retrieved from this incision below the fascia with a small Kelly clamp, tensioned and secured with a staple. The iliotibial tract defect is closed. Results: At long-term follow-up, a revision rate of 3% has been reported, while patient-reported outcome measures (PROMs) were excellent. At very-long-term follow-up, most patients were still involved in sports with a very low rate of positive Lachman and pivot shift tests. No overconstraint and lateral osteoarthritis were encountered. Medial osteoarthritis was related only to medial meniscectomy. Discussion/Conclusion: The ACL reconstruction plus LET over-the-top technique is a safe and reliable surgery with a low rate of reoperations and peri-operative complications at very-long-term follow-up. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.","PeriodicalId":485913,"journal":{"name":"Video journal of sports medicine","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135249435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Lateral extra-articular tenodesis (LET) is a reproducible and reliable technique to assist in control of rotational stability of the knee and decrease forces across an anterior cruciate ligament (ACL) graft in the setting of ACL reconstruction. Bone-tendon-bone (BTB) autograft is a common graft choice in revision ACL reconstruction. We present a technique for combining contralateral BTB autograft with LET in revision ACL reconstruction. Indications: This technique is indicated in patients undergoing ACL reconstruction who are at increased risk of graft failure, including revision cases, high-grade rotational instability, return to pivoting/cutting sports, ligamentous laxity, young age, meniscal deficiency, and hyperextension/recurvatum. Technique Description: The contralateral BTB autograft is harvested through standard fashion. We begin with the LET dissection prior to fluid infiltration in the soft tissues. A 1-cm strip of iliotibial (IT) band is harvested and whipstitched. The IT band strip is passed from anterior to posterior deep to the lateral collateral ligament (LCL). The LET socket is aimed 10° proximal and 10° anterior to limit tunnel convergence with the ACL. The LET is fixed with a tenodesis screw with the knee in neutral rotation and 30° of flexion. The ACL femoral socket is then placed, and care is taken to avoid convergence. A 10-mm tibial tunnel is drilled near the level of the posterior margin of the anterior horn of the lateral meniscus. The ACL is subsequently fixed with standard techniques. Results: The addition of LET to revision ACL has been shown to improve failure rate and outcomes. The use of contralateral patella tendon graft reduces morbidity on the operated leg. Notably, the position of the femoral LET tunnel is less important than the ACL tunnel position on the femur. If the LET is passed under the LCL, then the fixation point on femur becomes less relevant. The technique presented is a time-efficient way for combining tenodesis with revision ACL. Discussion/Conclusion: Performing a revision ACL reconstruction utilizing contralateral donor tissue with the addition of LET is a viable and reliable option for competitive athletes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.
{"title":"Revision ACL-R With Contralateral BTB Autograft and Iliotibial Band Lateral Extra-Articular Tenodesis With Interference Screw Fixation: A Technique Video","authors":"Brian Forsythe, Vahram Gamsarian, Amanda Pan, Vikranth Mirle, Enrico Forlenza, Sachin Allahabadi","doi":"10.1177/26350254231205909","DOIUrl":"https://doi.org/10.1177/26350254231205909","url":null,"abstract":"Background: Lateral extra-articular tenodesis (LET) is a reproducible and reliable technique to assist in control of rotational stability of the knee and decrease forces across an anterior cruciate ligament (ACL) graft in the setting of ACL reconstruction. Bone-tendon-bone (BTB) autograft is a common graft choice in revision ACL reconstruction. We present a technique for combining contralateral BTB autograft with LET in revision ACL reconstruction. Indications: This technique is indicated in patients undergoing ACL reconstruction who are at increased risk of graft failure, including revision cases, high-grade rotational instability, return to pivoting/cutting sports, ligamentous laxity, young age, meniscal deficiency, and hyperextension/recurvatum. Technique Description: The contralateral BTB autograft is harvested through standard fashion. We begin with the LET dissection prior to fluid infiltration in the soft tissues. A 1-cm strip of iliotibial (IT) band is harvested and whipstitched. The IT band strip is passed from anterior to posterior deep to the lateral collateral ligament (LCL). The LET socket is aimed 10° proximal and 10° anterior to limit tunnel convergence with the ACL. The LET is fixed with a tenodesis screw with the knee in neutral rotation and 30° of flexion. The ACL femoral socket is then placed, and care is taken to avoid convergence. A 10-mm tibial tunnel is drilled near the level of the posterior margin of the anterior horn of the lateral meniscus. The ACL is subsequently fixed with standard techniques. Results: The addition of LET to revision ACL has been shown to improve failure rate and outcomes. The use of contralateral patella tendon graft reduces morbidity on the operated leg. Notably, the position of the femoral LET tunnel is less important than the ACL tunnel position on the femur. If the LET is passed under the LCL, then the fixation point on femur becomes less relevant. The technique presented is a time-efficient way for combining tenodesis with revision ACL. Discussion/Conclusion: Performing a revision ACL reconstruction utilizing contralateral donor tissue with the addition of LET is a viable and reliable option for competitive athletes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.","PeriodicalId":485913,"journal":{"name":"Video journal of sports medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135737756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1177/26350254231200038
Søren Vindfeld, Line Lindanger, Eivind Inderhaug
Background: Tunnel widening, slightly malplaced former tunnels or bone loss due to hardware removal might prevent a 1-stage anterior cruciate ligament (ACL) revision procedure due to tunnel convergence or challenging graft fixation. A range of graft sources and bone grafting techniques are described—all with their strengths and limitations. Common autograft techniques come with substantial donor site morbidity that might hinder postoperative rehabilitation. Indications: Graft tunnel issues might prompt the need for structural grafts and a 2-stage ACL revision approach. The use of the current dowel allograft technique gives a flexible approach where 1 or several cylindrical grafts can be placed in prepared sockets for reliable bony ingrowth. Technique Description: Using femoral head allografts and cannulated coring reamers, multiple bone dowels (up to 6) can give a flexible and adaptable bone grafting situation. The intra-articular tunnels are dilated, and dowels are produced to allow a press-fit fixation that facilitates good bone healing. Removal of sclerotic bone and microfracture is key to allow optimal bone-to-bone healing. Use of cannulas inserted through the arthroscopic portals and tamps plug advancement will give a reliable graft deployment without dowel breakage. Results: The current authors have used this uniform technique for 119 patients since 2014. All cases displayed good bony healing at 5 months after surgery on computed tomography and radiographs, and 115 out of 119 went on to have a stage 2 revision ACL surgery at 6 months spacing from the bone grafting. The most common reason for not going through the second-stage revision was improvement of symptoms due to graft removal and bone grafting during the first surgery. Discussion/Conclusion: The current allograft dowel bone grafting allows for a flexible bone grafting in cases where a 1-step ACL revision procedure is not feasible. Reliable bony ingrowth is seen in the current cohort allowing the final step of ACL revision at 6 months spacing from bone grafting. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
{"title":"Allogenous Bone Grafting Technique for Staged Revision Anterior Cruciate Ligament Surgery","authors":"Søren Vindfeld, Line Lindanger, Eivind Inderhaug","doi":"10.1177/26350254231200038","DOIUrl":"https://doi.org/10.1177/26350254231200038","url":null,"abstract":"Background: Tunnel widening, slightly malplaced former tunnels or bone loss due to hardware removal might prevent a 1-stage anterior cruciate ligament (ACL) revision procedure due to tunnel convergence or challenging graft fixation. A range of graft sources and bone grafting techniques are described—all with their strengths and limitations. Common autograft techniques come with substantial donor site morbidity that might hinder postoperative rehabilitation. Indications: Graft tunnel issues might prompt the need for structural grafts and a 2-stage ACL revision approach. The use of the current dowel allograft technique gives a flexible approach where 1 or several cylindrical grafts can be placed in prepared sockets for reliable bony ingrowth. Technique Description: Using femoral head allografts and cannulated coring reamers, multiple bone dowels (up to 6) can give a flexible and adaptable bone grafting situation. The intra-articular tunnels are dilated, and dowels are produced to allow a press-fit fixation that facilitates good bone healing. Removal of sclerotic bone and microfracture is key to allow optimal bone-to-bone healing. Use of cannulas inserted through the arthroscopic portals and tamps plug advancement will give a reliable graft deployment without dowel breakage. Results: The current authors have used this uniform technique for 119 patients since 2014. All cases displayed good bony healing at 5 months after surgery on computed tomography and radiographs, and 115 out of 119 went on to have a stage 2 revision ACL surgery at 6 months spacing from the bone grafting. The most common reason for not going through the second-stage revision was improvement of symptoms due to graft removal and bone grafting during the first surgery. Discussion/Conclusion: The current allograft dowel bone grafting allows for a flexible bone grafting in cases where a 1-step ACL revision procedure is not feasible. Reliable bony ingrowth is seen in the current cohort allowing the final step of ACL revision at 6 months spacing from bone grafting. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.","PeriodicalId":485913,"journal":{"name":"Video journal of sports medicine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135587904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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