KNEE JOINT INJURY MECHANISMS AND INJURY CRITERIA IN … · KNEE JOINT INJURY MECHANISMS AND INJURY...
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IRCOBI Conference – Madrid (Spain), September 2006 319
KNEE JOINT INJURY MECHANISMS AND INJURY CRITERIA IN FULL
²SCALE TESTS ACCORDING TO IMPACT POSITION
ARNOUX P.J.1, THOLLON L.
1, BEHR M.
1, BRUNET C.
1 CESARI D.
2
1 Laboratoire de Biomécanique Appliquée, UMRT 24 Faculté de Médecine - INRETS, Université de la
Méditerranée, Marseille, France. 2 INRETS, Scientific direction, Bron, France.
ABSTRACT
In pedestrian safety research, the definition of an injury criterion for the knee joint should provide
issues to future regulation procedures. Also, do the existing injury criteria (based on knee lateral
shearing levels and flexion levels for sub-segment testing) remain efficient for full scale tests? Is the
impact location on the leg influencing injury mechanisms and injury criteria assumptions? Lastly,
what are the potential consequences of these differences to the pelvis component during the first phase
of impact? The LLMS lower limb model coupled to a hybrid 3 was used to investigate these questions.
This work was based on pedestrian full scale experiments performed in the Laboratory and a
sensitivity analysis regarding various impact positions. The results obtained for this car geometry
showed that injury mechanisms (i. e. the proportion of shearing and lateral flexion) for the knee joint
and the pelvis are directly related to the impact position. Lastly they lead to improve existing injury
criteria by adding combination of two injury modes.
Keywords: PEDESTRIANS, INJURY CRITERIA, KNEES, LEGS, FINITE ELEMENT METHOD
IN PEDESTRIAN CAR ACCIDENT a large field of research is devoted to the development of
vehicle safety countermeasures directed towards the response of the human knee joint. A large portion
of this research concerns the experimental investigation of human body behaviour through cadaver
experiments, the design and validation of human lower limb models or mechanical surrogates. All
these works try to investigate injury mechanisms, injury criteria by correlation to trauma situation and
consequently car safety efficiency.
From an experimental point of view, during a pedestrian impact, knee injuries could result from a
combination of lateral shearing and bending of the knee (Kajzer 1990 and 1993, Teresinski 2001, Bose
2004). Pure shearing induces collateral tibial and anterior cruciate ligaments failure while a primarily
bending mainly induces medial collateral ligament failure. More recently, Bose (2004) performed 3-
point bending tests on isolated knee joints in order to obtain a combination of shearing and bending
effects, and confirmed injuries to medial collateral and anterior cruciate ligaments. It can be noted that
knee injuries are not restricted to the injuries described above. Tibia fractures (especially with at the
tibial eminence in contact with the intercondylar notch at impact), posterior cruciate ligament injuries,
fibula and femur fractures can also be observed. From all these studies, it appears that the main
challenge for improving leg protection should focus on knee ligament damage and failure
minimization. This challenge should not be managed separately as what’s happened on the hip joint
components. With various car designs, lower limb behaviour can differs according to the shape of the
car and the impacts position and modify knee joint loadings and the induced kinematics.
In the specific field of numerical simulation, multibody mathematical models were used in order
to provide an overall insight to the kinematics involved in pedestrian impact loading (Yang et al.,
1994, Wismans et al., 1980, Serre et al. 2005). In order to provide an accurate investigation of trauma
chronology during the impact, finite elements model has been design since the past 10 years. The first
models, designed by Bermond (1994) and Yang (1996) were dedicated to pedestrian loading cases
especially sub segment tests performed by Kajzer (1990 & 1993). The more recent lower limb FE

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models (Schuster et al. (2000), Arnoux et al. (2002) and Beillas (2001), Chawla et al. (2004)) focused
on an accurate description of anatomical components that are involved in joint mechanics or are
injured during trauma situations. In these models, material properties were obtained from individual
tissue testing and try to integrate damage and failure of deformable bone and soft tissue structures.
These models are then validated against sub-segment and full scale post mortem human subject
(PMHS) in various loading configuration in order to evaluate mechanical behaviour of the whole
structure. Besides validating for overall impact response some of the more advanced models, as they
can record data not available experimentally, are capable of predicting injury mechanisms and thus
help define injury tolerances (Takahashi et al. (2003), Nagasaka et al., (2003), Chawla et al. (2004),
Arnoux et al. 2005). In Nagasaka pedestrian lower limb model, injuries are based on the height and
angle of the impact to include a wide range of vehicle geometry and impact configuration. Based on
similar objectives of understanding lower limb injury mechanisms and estimating injury thresholds we
have evaluated the ultimate bending angle and shear displacement threshold for ligament failure to be
15-200 and 13-15mm respectively on the base of available sub segment tests (Arnoux et al. 2005) and
Bose et al. (2006)). The LLMS model used for the study was developed by Arnoux et al. (2001) and
Beillas et al. (2001). An accurate geometric model of a 50th % adult male was reconstructed using MRI
measurements. The total number of elements was close to 35,000 with characteristic length chosen to
obtain initial time step ranging from 0.8 to 1ȝs. Material properties for each tissue component were
determined from previously published PMHS studies. To validate the material response of the model,
validation was performed at three levels: isolated tissue tests, sub-segment tests and finally entire
lower limb tests (Table 1)
Table 1 : Validation tests performed on LLMS model
Validation Tests Parameters
Soft Tissue Tensile Tests
Anterior Cruciate Ligament Force, Displacement
Posterior Cruciate Ligament Force, Displacement
Medial collateral Ligament Force, Displacement
Lateral collateral Ligament Force, Displacement
Patellar Tendon Stress, Strain
Long Bone Tests
Femur Bending (3-points) Force, Displacement
Tibial Lateral-Medial Bending Force
Tibial Antero-posterior Bending Force
Sub-Segment Loading
Patellar impact on flexed knee Force
Tibia impact on flexed knee Force
Anterior posterior flexed knee Force, Displacement
Quasi-static leg compression Force, Displacement
Quasi-static tibia/fibula comp. Force, Displacement
Ankle Inversion/Eversion/dorsiflexion Moment Rotation
Three point knee bending Moment Rotation
Four point knee bending Moment Rotation
Whole Lower Limb tests
Pedestrian lateral bending Force, Rotation
Pedestrian lateral shearing Force
Frontal Sled test Force
The present study aims at investigate these injury mechanisms regarding real full scale pedestrian
crash situations. In particular, for a defined car model, the question is related to the influence of impact
position on injury mechanisms and injury criteria definition on the knee joint. Additionally the
possible consequences at the hip joint level regarding kinematics and transmitted loads were
investigated. To achieve this, the injury prediction capability of LLMS-hybrid III were investigated
regarding a real pedestrian experimental tests performed in the laboratory. The injury mechanisms
evaluation was based on certain model parameters (e.g. local strain in soft tissues, Von Mises stress in
bones, internal energy) which cannot be measured in experimental tests. In particular, by assuming
that ligaments failure is related to strain level, the knee joint injury threshold is based on the
relationship between admissible strain levels in the ligaments and overall knee joint kinematics such as
lateral flexion and shearing, torsion effects.

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INJURY MECHANISMS & CRITERIA EVALUATION IN PEDESTRIAN IMPACTS
THE LLMS MODEL FOR PEDESTRIAN used for this work was coupled to an Hybrid III 50
percentile rigid dummy model in order to take into account the effects of the whole human body
kinematics during the test. The details of LLMS model (from design to validation) were not reported
in this paper as they were already largely published (Arnoux 2001, 2004, 2005, Beillas 2001).
The coupling consisted in adding a part of the pelvis bone to the initial pelvis rigid body component.
The initial geometry of a hybrid pelvis was modified in order to ensure repositioning of the model up
to the standing position (cf. figure 1.). The upper proximal femur to the head of femur was considered
as a rigid body. The hip joint was then defined using a mathematical joint at the centre of the femoral
head. Rotations at the hip joint were defined using torque versus angle user functions in a local skew
system (cf. figure 1).
Fig. 1 – Overview of LLMS Hybrid 3 coupling on the pelvis segment
The model reference pedestrian impact test was relevant with experimental tests performed in the
context of a French APPA (“Amélioration de la protection des piétons lors de collisions avec des
automobiles”) PREDIT (“Programme de Recherche et d’inovation dans les transports terrestres”)
project. It consists in putting the model (50 percentile one as for experiment) in standing position in
front of a “Euroncap supermini (segment B)” class finite element car model. The car model was then
put in braking conditions (pitching angle ~ 2°) with an initial velocity of 10.88ms-1 and, according to
the acceleration recorded during experiments; we postulated a constant deceleration of 5.58 ms-2. As it
was performed during experiment, the pedestrian model and more particularly the impacted leg was
set into a light flexion at the same height of the knee joint in front of the car bumper (figure 2). The
analysis performed in this work focus only on lower limb behaviour for the first phase of the
pedestrian impact until first injuries appears on the leg (figure 2).
Fig. 2 –Illustration of LLMS Hybrid 3 kinematics in the first phase of the impact and Von Mises
curve on bones components
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THE INJURY MECHANISMS EVALUATION was based on same methodology as in previous work
(Arnoux et al., 2004).Although the material definition of the FE knee model did not include failure
behaviour, however specific parameters like ligament strain bone stress were recorded in balance to
joint kinematics to estimate failure and injury mechanisms timings. To measure ligament strain in the
model, several uni-axial low stiffness springs (length approximately equal to twice element
dimension) were assembled in series along the main axis of each ligament and pasted to ligament
structure. During post processing individual spring extension was recorded and computed to provide
strain level by comparison to initial length of each spring. Then the global strain for each ligament
(computed as the mean strain level along the ligament) was used to illustrate strain levels in the
ligament. In the present work, the failure threshold values (Table 2) were compared to the global strain
level. The maximum curve of local strain level was obtained by defining the curve of maximum of
local strain. It was used as an additional indication to the structure strain field (homogenous for lateral
ligaments whereas strong dispersions appeared for cruciates). High local strain level could be
understood as additional information to determine the failure risk and location.
In previous studies (Arnoux et al. 2004, 2005), injury criteria were obtained through numerical
investigation on sub segment tests. Once the model is assumed to be validated, the next step of this
approach was to record not experimentally available data such as ligament strain level. Assuming that
ultimate strain is a failure criteria for ligament, the injury criteria previously investigated was based on
the relationship between knee ligaments strain level and knee joint kinematics. This previous work led
to postulate on an injury criteria in pure shearing (13-15mm) and in pure lateral flexion (15-20°).
Table 2: Tissue failure threshold values used for predicting model failure (Arnoux et al., 2005)
Failure Threshold ValuesLigaments Strain
Collateral MCL, LCL 28%
Cruciate ACL, PCL 22%
Bones Ultimate Stress
Femur 125 MPa
Tibia Metaphysis 130MPa
Epiphysis 110MPa
Patella 125MPa
Fibula Head 125MPa
Diaphysis 100MPa
For this test, the collateral medial ligament and posterior cruciate ligament were both injured in
the first phase of the impact with an approximated time for failure at around 9-10ms (figure 3). A
complementary analysis of strain distribution along the ligaments showed very high strain level at
ligament insertion which let us to postulate on a potential failure at ligament insertions
Fig. 3 –knee ligaments (maximum and total) strain level in the first phase of the impact
From von Mises distribution, damage and failure on bones occurs on the proximal fibula due to the
contact with the bumper (figure 4). No femur or tibia failure was reported, but Von Mises distribution
Total Strain level in S3-PED2B
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Max Strain level in S3-PED2B
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was located on distal femur metaphysic and proximal tibia metaphysis with maximum amplitude
around 100-120MPa.
With the analysis of rotation and lateral shearing of the knee, we observed lateral rotation effects
(around 12-15°) but a very small lateral shearing (lower than 5 mm) (figure 5). An additional
significant translation along the limb axes was observed and reached 10mm. Note that in this case,
torsion effects (reaching 5°at the first injury time) were observed. This phenomenon also observed for
sub segment was described as a natural safety countermeasure for ligaments recruitment in the knee
joint.
Fig. 4 –Von Mises stress distribution (MPa) on tibia fibula with failure location on fibular
component
Fig. 5 –Knee joint rotations and shearing level (Y for lateral shearing).
In previous work, the knee joint injury criteria were postulated on the bases of Kajzer and Bose
experimental tests. The results obtained with real car impact show that the ligaments injury seems to
be related to the combination of the two classical lateral shearing and flexion, and a new one
(regarding numerical simulation) which is the stretching on the knee joint along the leg axes. The
shearing and lateral flexion levels obtained are below already defined injury thresholds. These results
lead us to assume that the injury criteria should be improved by defining a relation between shearing,
bending (and also by stretching effects).
INFLUENCE OF IMPACT POSITION
Due to knee joint mechanics, the impact position in pedestrian is assumed to be determinant to the
injury mechanisms observed and consequently the definition or relevance of injury criteria. In order to
investigate quantitatively this situation, several numerical simulations were performed with various
realistic impact position from the medial femur, femur metaphysic, distal femur metaphysic, centred
on knee joint, and lastly on proximal tibia metaphysic. This position were obtained through a vertical
positioning of the car model. For these various situation, the same methodology as described in
Knee shearing in C3-PED2B
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previous section was applied in order to evaluate injury mechanisms.
FOR THE UPPER FEMUR IMPACT, the front car bumper was set to the 2/3 inferior of the femur
(figure 6) which is 165mm above the reference impact position. The conditions of the impact car
velocity and deceleration are the same as those described in previous section. In the beginning of the
shocks (for the first 12ms), ligaments strain level recorded on lateral were largely below injury
threshold with strain level below 18%. For cruciate ligaments, maximum local strain curve show an
inhomogeneous strain field with a tibial ligament insertion highly recruited (it reach the ultimate
threshold) due to shearing effects. At the end of the first phase, after bone failure (see below), the knee
joint structure is highly recruited with and LCA potential failure.
Knee joint kinematics showed differences with the reference test. Whereas stretching effects
(Shear Z) were constant, the shearing effects were dominant in the first 10ms with level below the
13mm criteria value defined in previous works. On the opposite, once bone failure occurred, the
shearing effects decrease and lateral flexion reach 20° at the time of anterior cruciate ligament
potential failure.
Regarding Von Mises Stress curve, if stress concentration seems to be located on the same area as
for previous tests, due to front car shape, the femur is recruited as a three point flexion in the opposite
directions as in the reference test. This loading leads to bone failure at time closed to 11ms.
Fig. 6 – Four steps of lower limb kinematics and Von Mises stress iso curves on bones for the
pedestrian upper femur impact.
In the upper femur impact test, the knee joint kinematics seems to be a combination of dominant
lateral shearing coupled with lateral flexion until the bone failure which is first injury mechanisms
observed. Once bone failure occurred, the knee joint exhibit a dominant lateral flexion leading to
ligaments injury with amplitude of 20° which is relevant to previous criteria.
Max Strain level in C3-PED2E
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Knee rotations in C3-PED2E
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Fig. 7 – Upper femur impact : Knee ligaments maximum and total strain level, Joint kinematics
with Shear Y for anterior posterior degree of freedoms, Shear Y for lateral shearing, Shear Z
for stretching effects on the leg
FOR DISTAL FEMUR IMPACT, the front car bumper was set in front of the femur distal metaphysic
which is 95mm above the reference impact position. Impact conditions are same as described in
previous tests. The strain curves analysis on ligaments indicates a potential failure of the medial
collateral ligament and posterior cruciate ligament (for time ranged from 12 to 14ms). Regarding knee
joint kinematics (figure 8 & 9), this potential failure was obtained for of coupled lateral flexion (~12 to
16°) and lateral shearing effect (~11 to 13mm). This result showed that combination of the two
mechanisms leading to ligament failure. Note that front car shape, in particular the lower bumper is
simultaneously in contact with lower tibia during the injury mechanisms which could limit the lateral
flexion level. For femur and tibia bones, the Von Mises curves showed same location with flexion
effects on femur metaphysic which lead to same failure situation as for the upper femur impact at
20ms (later than ligaments injuries).
Fig. 8 – Three steps of lower limb kinematics and Von Mises stress iso curves on bones for the
pedestrian distal femur impact.
Max Strain level in C3-PED2C
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Knee rotations in C3-PED2C
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Fig. 9 – Distal femur impact : Knee ligaments maximum and total strain level, Joint kinematics
with Shear Y for anterior posterior degree of freedoms, Shear Y for lateral shearing, Shear Z
for stretching effects on the leg
FOR KNEE JOINT IMPACT, the impact occurs on the middle of the knee joint (30mm above
reference impact tests) with both primary contact with tibia and femur bones and with same conditions
as previous tests (figure 10 & 11). Regarding strain level distribution, the posterior cruciate ligament
and medial collateral ligament seems to be injured in the first 7 to 9 ms and then anterior cruciate
ligaments. The maximum local strain recorded confirmed these assumptions. The knee joint
kinematics is similar to the previous test with a combination of lateral flexion (8-10°), lateral shearing
(10-11mm) and also stretching effects. The front car shape, in particular the lower bumper, is
simultaneously in contact with lower tibia during the injury mechanisms which could limit the lateral
flexion amplitude. This result indicates that injury criteria should be here a combination between
shearing and lateral flexion. Regarding bone structures, Von Mises curves reach values closed to
failure limits but didn’t fail.
Max Strain level in C3-PED2F
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Fig. 10 – Knee joint impact : Knee ligaments maximum and total strain level, Joint kinematics
with Shear Y for anterior posterior degree of freedoms, Shear Y for lateral shearing, Shear Z
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Fig. 11 – Three steps of lower limb kinematics and Von Mises stress iso curves on bones for the
pedestrian knee joint impact.
FOR METAPHYSIS TIBIA IMPACT, the contact with front car occurred on the proximal tibia
metaphysic (figure 12) 45mm below reference impact position. The knee ligaments failure was
postulated firstly for the two cruciate ligaments at 8ms and then for the medial collateral ligament
closed to 10ms. Regarding knee joint kinematics (figure 12 & 13), lateral flexion effects is closed to 5°
whereas lateral shearing is dominant and reaches the failure criteria of 13mm. Von Mises stress curves
showed that bone structure were highly constraints with failure after ligaments injuries. This failure
was observed on the 1/3 of tibia bone and seems to be induced by tibia lateral flexion.
Fig. 12 – Three steps of lower limb kinematics and Von Mises stress iso curves on bones for the
pedestrian metaphysic tibia impact.
Max Strain level in C3-PED2D
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Knee rotations in C3-PED2D
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Fig. 13 – Metaphysis tibia impact : Knee ligaments maximum and total strain level, Joint
kinematics with Shear Y for anterior posterior degree of freedoms, Shear Y for lateral shearing,
Shear Z for stretching effects on the leg
DISCUSSION CONCLUSION
The Lower Limb Model for Safety has been designed to describe multiple loading configurations.
Once the model is assumed to be well validated, it can be used for predicting injury response for a
much wider range of loading parameters. The degree of uncertainty associated with identifying injury
events is reduced by defining injury thresholds based on specific parameters like ligament strain and
bone stress which can also related to joint kinematics. In previous works (Arnoux et al. 2004, Bose et
al. 2006), we had investigated the definition of a knee joint injury criteria for pedestrian impacts on the
base of Kajzer and Bose-Kerrigan previous works (Kajzer et al. 1990, 1993, Bose 2004, Kerrigan
2003). The first criteria, 13mm in lateral shearing and 18° in lateral flexion, was efficient for pure
shearing or lateral flexion but was not really studied for the combination of the two mechanisms. For
full scale pedestrian simulations, we observed that the two mechanisms occurred simultaneously with
various amplitudes according to the impact location (table 3).
Table 3: Injury mechanisms synthesis; The numbering (from 1 to 3) in colon was add in order to
describe the first mechanisms. The injury criteria column let to complete the injury criteria
definition
Impact location Injury mechanisms Joint injuries Injury criteria Bones injuriesTibia Prox Shearing dominant 1. The two cruciates
2. Medial collateral ligament
13 mm 3. Tibia
Knee Joint Shearing : 10-11mm
Flexion : 8-10° + Stretching
1. Posterior cruciate ligament
2. Medial collateral ligament
10° & 10mm
Femur Distal Metaphysis Flexion: 12-16°
Shearing : 11-13mm
1. Medial collateral2. Posterior cruciate ligament
14° & 11mm 3. Femur
Upper Femur
1. Shearing dominant
2. Flexion dominant 3. Medial collateral ligament 20°
1. Femur
From these results, as impact occurred on leg, the shearing is dominant with a 13mm lateral
shearing injury criteria. If impact occurs on knee joint, there is a combination of lateral shearing and
flexion. On the opposite, an impact located on femur induces a dominant shearing with an associated
minor lateral flexion. Consequently, we can improve injury criteria by adding the coupled 14° lateral
flexion and 11mm of shearing in the definition of knee joint injury criteria. Notes these results are
directly related to the front car geometry studied in this work which induce a limitation of lateral
flexion effects for impact on knee joint. In a next step, they should be confirmed for various front car
geometries. Moreover, the knee gets impacted with structures of different stiffness (due to various
positions). This point need to be also investigated in order to evaluate the potential influence of the
local car component stiffness on knee joint injury mechanisms.
Regarding the injury risk for knee joint, more the impact location was high, more the ligaments

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injuries occurred later. On the contrary this trend increases the bone failure risk with a three point
failure mode for the femur. Hence, if high impact location seems to minimize (or add delay) on knee
joint loading and its potential injury. The consequences for hip joint and consequently pelvis seem to
follow the same trends i. e. increase of transmitted force and kinematics with height of impact
location. This point should be carefully investigated in further works. Then, regarding safety
regulation directive, the future choices for knee joint impact location should be linked to those for
pelvis impact. If the impact location is centred on knee joint or on tibia, we can assume that needs to
investigate pelvis behaviour regarding first impact phase are minor. On the contrary, for impact
occurring on femur component or upper, it could be essential to investigate pelvis behaviour.
The results obtained in this work show that stretching effects occurred during some tests which
leads to increase strain levels on ligaments (especially with cruciates ones). It is therefore difficult to
conclude on the relevance of these effects. Passive and Active muscle contribution is also expected to
affect the knee joint stability in emergency pedestrian-car impact situations and its implementation to
numerical models such as this should be investigated (only passive behaviour of the muscle groups is
described). The further tests will be performed on model version including active or passive muscle
behaviour (Behr et al. 2006).
The LLMS model presents also limitations in terms of descriptions of mechanical properties of
biological tissues. More particularly, the damage and unsymmetrical behaviour laws were not included
in the model at this stage, which limits the model validity to the first ligament failure. These first
results have to be improved with further developments, including damage and failure properties. The
questions of model sensitivity need to be further investigated (through mesh influence, ligaments and
bone ultimate thresholds and also main mechanical parameters such as Young modulus). Current work
in progress will lead to improve model definition and will let to confirm and to describe more
accurately, mechanisms investigated in this work.
Acknowledgment
We would like to acknowledge the technical staff of the laboratory which were in charge of experiments
essential to the validation and evaluation of the numerical model. We would also acknowledge Mecalog for their
close collaboration as co-designer of the lower limb model. Lastly we would like to acknowledge all partners of
the PREDIT APPA project (Mecalog, Faurecia, INRETS MA, INRETS UMRETTE, UTAC and LAB PSA-
Renault) for their contribution especially providing the numerical model of the car front.
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