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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2020

01-06-2020 | KNEE

Increased lateral meniscal slope is associated with greater incidence of lateral bone contusions in noncontact ACL injury

Authors: Ke Li, Jia Li, Xiaoqing Zheng, Vincent Marot, Jérôme Murgier, Etienne Cavaignac, Wei Huang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2020

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Abstract

Purpose

(1) To investigate whether an increased lateral meniscal slope measured on magnetic resonance image (MRI) would be associated with greater risk of bone contusions in noncontact anterior cruciate ligament injury, and (2) to measure the relationship between the occurrence of bone contusions and associated findings observed in ACL deficient knees such as cartilage damage, anterolateral complex injury and concomitant meniscal tears.

Method

Patients who underwent ACL reconstruction surgery between 2013 and 2018 were retrospectively reviewed. Sixty-three patients were included in the study group (ACL + bone contusions group), 56 participants were in the control group (isolated ACL group). The presence and severity of bone contusions were determined from preoperative MRIs. The lateral meniscal slope and lateral posterior tibial slope were measured on the MRIs in a blinded fashion. The predictors of lateral bone contusions including age, sex, body mass index, lateral meniscal slope and lateral posterior tibial slope were examined by multivariable logistic regression. Associated findings including concomitant meniscal lesions, intra-articular cartilage damage and anterolateral complex injury, which were also calculated by multivariable logistic regression.

Results

The mean lateral meniscal slope in the study group was 6.5° ± 3.5°, which was significantly larger than that in the control group (3.8° ± 2.7°; P < 0.01). In addition, increased lateral meniscal slope was significantly associated with lateral bone contusions in noncontact ACL injury (Lateral femoral condyle (LFC): AOR 16.5; 95% CI 5.40–50.20; P < 0.01; Lateral tibial plateau (LTP): AOR 31.8; 95% CI 8.68–116.7; P < 0.01). However, lateral posterior tibial slope was not significantly associated with bone contusions. Moreover, the presence of lateral bone contusions was associated with concomitant lateral meniscal tears (OR 12.4; 95% CI 3.30–46.30) and cartilage damage (OR 2.9; 95% CI 1.04–8.18).

Conclusion

An increased lateral meniscal slope was associated with increased risk of lateral bone contusions in noncontact ACL injury. In addition, the presence of lateral bone contusions was associated with intra-articular cartilage damage, anterolateral complex injury and concomitant meniscal tears. Hence, additional information was provided for counseling patients who have increased LMS on the greater risk of knee rotational instability and identify patients undergoing ACL reconstruction who may benefit from extra-articular tenodesis.

Level of evidence

IV.
Literature
1.
go back to reference Bisson LJ, Gurske-DePerio J (2010) Axial and sagittal knee geometry as a risk factor for noncontact anterior cruciate ligament tear: a case-control study. Arthroscopy 26(7):901–906CrossRefPubMed Bisson LJ, Gurske-DePerio J (2010) Axial and sagittal knee geometry as a risk factor for noncontact anterior cruciate ligament tear: a case-control study. Arthroscopy 26(7):901–906CrossRefPubMed
2.
go back to reference Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23(6):573–578CrossRefPubMed Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr (2000) Mechanisms of anterior cruciate ligament injury. Orthopedics 23(6):573–578CrossRefPubMed
3.
go back to reference Bretlau T, Tuxoe J, Larsen L, Jorgensen U, Thomsen HS, Lausten GS (2002) Bone bruise in the acutely injured knee. Knee Surg Sports Traumatol Arthrosc 10(2):96–101CrossRefPubMed Bretlau T, Tuxoe J, Larsen L, Jorgensen U, Thomsen HS, Lausten GS (2002) Bone bruise in the acutely injured knee. Knee Surg Sports Traumatol Arthrosc 10(2):96–101CrossRefPubMed
4.
go back to reference Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85A(Suppl 2):58–69CrossRef Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85A(Suppl 2):58–69CrossRef
5.
go back to reference Costa-Paz M, Muscolo DL, Ayerza M, Makino A, Aponte-Tinao L (2001) Magnetic resonance imaging follow-up study of bone bruises associated with anterior cruciate ligament ruptures. Arthroscopy 17(5):445–449CrossRefPubMed Costa-Paz M, Muscolo DL, Ayerza M, Makino A, Aponte-Tinao L (2001) Magnetic resonance imaging follow-up study of bone bruises associated with anterior cruciate ligament ruptures. Arthroscopy 17(5):445–449CrossRefPubMed
6.
go back to reference Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med 22(5):632–644CrossRefPubMed Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med 22(5):632–644CrossRefPubMed
7.
go back to reference Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br 76(5):745–749CrossRefPubMed Dejour H, Bonnin M (1994) Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared. J Bone Joint Surg Br 76(5):745–749CrossRefPubMed
8.
go back to reference Elmansori A, Lording T, Dumas R, Elmajri K, Neyret P, Lustig S (2017) Proximal tibial bony and meniscal slopes are higher in ACL injured subjects than controls: a comparative MRI study. Knee Surg Sports Traumatol Arthrosc 25(5):1598–1605CrossRefPubMed Elmansori A, Lording T, Dumas R, Elmajri K, Neyret P, Lustig S (2017) Proximal tibial bony and meniscal slopes are higher in ACL injured subjects than controls: a comparative MRI study. Knee Surg Sports Traumatol Arthrosc 25(5):1598–1605CrossRefPubMed
9.
go back to reference Faber KJ, Dill JR, Amendola A, Thain L, Spouge A, Fowler PJ (1999) Occult osteochondral lesions after anterior cruciate ligament rupture. Six-year magnetic resonance imaging follow-up study. Am J Sports Med 27(4):489–494CrossRefPubMed Faber KJ, Dill JR, Amendola A, Thain L, Spouge A, Fowler PJ (1999) Occult osteochondral lesions after anterior cruciate ligament rupture. Six-year magnetic resonance imaging follow-up study. Am J Sports Med 27(4):489–494CrossRefPubMed
10.
go back to reference Feucht MJ, Mauro CS, Brucker PU, Imhoff AB, Hinterwimmer S (2013) The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 21(1):134–145CrossRefPubMed Feucht MJ, Mauro CS, Brucker PU, Imhoff AB, Hinterwimmer S (2013) The role of the tibial slope in sustaining and treating anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 21(1):134–145CrossRefPubMed
11.
go back to reference Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med 33(3):335–346CrossRefPubMed Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med 33(3):335–346CrossRefPubMed
12.
go back to reference Frobell RB (2011) Change in cartilage thickness, posttraumatic bone marrow lesions, and joint fluid volumes after acute ACL disruption: a two-year prospective MRI study of sixty-one subjects. J Bone Joint Surg Am 93(12):1096–1103CrossRefPubMed Frobell RB (2011) Change in cartilage thickness, posttraumatic bone marrow lesions, and joint fluid volumes after acute ACL disruption: a two-year prospective MRI study of sixty-one subjects. J Bone Joint Surg Am 93(12):1096–1103CrossRefPubMed
13.
go back to reference Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32(2):376–382CrossRefPubMed Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32(2):376–382CrossRefPubMed
14.
go back to reference Graf BK, Cook DA, De Smet AA, Keene JS (1993) “Bone bruises” on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med 21(2):220–223CrossRefPubMed Graf BK, Cook DA, De Smet AA, Keene JS (1993) “Bone bruises” on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med 21(2):220–223CrossRefPubMed
15.
go back to reference Helito CP, Helito PVP, Leao RV, Demange MK, Bordalo-Rodrigues M (2017) Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 25(4):1140–1148CrossRefPubMed Helito CP, Helito PVP, Leao RV, Demange MK, Bordalo-Rodrigues M (2017) Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 25(4):1140–1148CrossRefPubMed
16.
go back to reference Hudek R, Fuchs B, Regenfelder F, Koch PP (2011) Is noncontact ACL injury associated with the posterior tibial and meniscal slope? Clin Orthop Relat Res 469(8):2377–2384PubMedPubMedCentralCrossRef Hudek R, Fuchs B, Regenfelder F, Koch PP (2011) Is noncontact ACL injury associated with the posterior tibial and meniscal slope? Clin Orthop Relat Res 469(8):2377–2384PubMedPubMedCentralCrossRef
17.
go back to reference Illingworth KD, Hensler D, Casagranda B, Borrero C, van Eck CF, Fu FH (2014) Relationship between bone bruise volume and the presence of meniscal tears in acute anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 22(9):2181–2186PubMed Illingworth KD, Hensler D, Casagranda B, Borrero C, van Eck CF, Fu FH (2014) Relationship between bone bruise volume and the presence of meniscal tears in acute anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 22(9):2181–2186PubMed
18.
go back to reference Johnson DL, Urban WP Jr, Caborn DN, Vanarthos WJ, Carlson CS (1998) Articular cartilage changes seen with magnetic resonance imaging-detected bone bruises associated with acute anterior cruciate ligament rupture. Am J Sports Med 26(3):409–414CrossRefPubMed Johnson DL, Urban WP Jr, Caborn DN, Vanarthos WJ, Carlson CS (1998) Articular cartilage changes seen with magnetic resonance imaging-detected bone bruises associated with acute anterior cruciate ligament rupture. Am J Sports Med 26(3):409–414CrossRefPubMed
19.
go back to reference Kim SY, Spritzer CE, Utturkar GM, Toth AP, Garrett WE, DeFrate LE (2015) Knee kinematics during noncontact anterior cruciate ligament injury as determined from bone bruise location. Am J Sports Med 43(10):2515–2521PubMedPubMedCentralCrossRef Kim SY, Spritzer CE, Utturkar GM, Toth AP, Garrett WE, DeFrate LE (2015) Knee kinematics during noncontact anterior cruciate ligament injury as determined from bone bruise location. Am J Sports Med 43(10):2515–2521PubMedPubMedCentralCrossRef
20.
go back to reference Krosshaug T, Andersen TE, Olsen OE, Myklebust G, Bahr R (2005) Research approaches to describe the mechanisms of injuries in sport: limitations and possibilities. Br J Sports Med 39(6):330–339PubMedPubMedCentralCrossRef Krosshaug T, Andersen TE, Olsen OE, Myklebust G, Bahr R (2005) Research approaches to describe the mechanisms of injuries in sport: limitations and possibilities. Br J Sports Med 39(6):330–339PubMedPubMedCentralCrossRef
21.
go back to reference Lustig S, Scholes CJ, Leo SP, Coolican M, Parker DA (2013) Influence of soft tissues on the proximal bony tibial slope measured with two-dimensional MRI. Knee Surg Sports Traumatol Arthrosc 21(2):372–379CrossRefPubMed Lustig S, Scholes CJ, Leo SP, Coolican M, Parker DA (2013) Influence of soft tissues on the proximal bony tibial slope measured with two-dimensional MRI. Knee Surg Sports Traumatol Arthrosc 21(2):372–379CrossRefPubMed
22.
go back to reference Myklebust G, Holm I, Maehlum S, Engebretsen L, Bahr R (2003) Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study. Am J Sports Med 31(6):981–989CrossRefPubMed Myklebust G, Holm I, Maehlum S, Engebretsen L, Bahr R (2003) Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study. Am J Sports Med 31(6):981–989CrossRefPubMed
23.
go back to reference Nakamae A, Engebretsen L, Bahr R, Krosshaug T, Ochi M (2006) Natural history of bone bruises after acute knee injury: clinical outcome and histopathological findings. Knee Surg Sports Traumatol Arthrosc 14(12):1252–1258CrossRefPubMed Nakamae A, Engebretsen L, Bahr R, Krosshaug T, Ochi M (2006) Natural history of bone bruises after acute knee injury: clinical outcome and histopathological findings. Knee Surg Sports Traumatol Arthrosc 14(12):1252–1258CrossRefPubMed
24.
25.
go back to reference Papalia R, Torre G, Vasta S, Zampogna B, Pedersen DR, Denaro V, Amendola A (2015) Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence. Open Access J Sports Med 6:37–48PubMedPubMedCentral Papalia R, Torre G, Vasta S, Zampogna B, Pedersen DR, Denaro V, Amendola A (2015) Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence. Open Access J Sports Med 6:37–48PubMedPubMedCentral
26.
go back to reference Patel SA, Hageman J, Quatman CE, Wordeman SC, Hewett TE (2014) Prevalence and location of bone bruises associated with anterior cruciate ligament injury and implications for mechanism of injury: a systematic review. Sports Med 44(2):281–293PubMedPubMedCentralCrossRef Patel SA, Hageman J, Quatman CE, Wordeman SC, Hewett TE (2014) Prevalence and location of bone bruises associated with anterior cruciate ligament injury and implications for mechanism of injury: a systematic review. Sports Med 44(2):281–293PubMedPubMedCentralCrossRef
27.
go back to reference Puzzitiello RN, Agarwalla A, Zuke WA, Garcia GH, Forsythe B (2018) Imaging diagnosis of injury to the anterolateral ligament in patients with anterior cruciate ligaments: association of anterolateral ligament injury with other types of knee pathology and grade of pivot-shift examination: a systematic review. Arthroscopy 34(9):2728–2738CrossRefPubMed Puzzitiello RN, Agarwalla A, Zuke WA, Garcia GH, Forsythe B (2018) Imaging diagnosis of injury to the anterolateral ligament in patients with anterior cruciate ligaments: association of anterolateral ligament injury with other types of knee pathology and grade of pivot-shift examination: a systematic review. Arthroscopy 34(9):2728–2738CrossRefPubMed
28.
go back to reference Shaikh H, Herbst E, Rahnemai-Azar AA, Bottene Villa Albers M, Naendrup JH, Musahl V, Irrgang JJ, Fu FH (2017) The segond fracture is an avulsion of the anterolateral complex. Am J Sports Med 45(10):2247–2252CrossRefPubMed Shaikh H, Herbst E, Rahnemai-Azar AA, Bottene Villa Albers M, Naendrup JH, Musahl V, Irrgang JJ, Fu FH (2017) The segond fracture is an avulsion of the anterolateral complex. Am J Sports Med 45(10):2247–2252CrossRefPubMed
29.
go back to reference Song GY, Liu X, Zhang H, Wang QQ, Zhang J, Li Y, Feng H (2016) Increased medial meniscal slope is associated with greater risk of ramp lesion in noncontact anterior cruciate ligament injury. Am J Sports Med 44(8):2039–2046CrossRefPubMed Song GY, Liu X, Zhang H, Wang QQ, Zhang J, Li Y, Feng H (2016) Increased medial meniscal slope is associated with greater risk of ramp lesion in noncontact anterior cruciate ligament injury. Am J Sports Med 44(8):2039–2046CrossRefPubMed
30.
go back to reference Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H (2016) Bone contusions after acute noncontact anterior cruciate ligament injury are associated with knee joint laxity, concomitant meniscal lesions, and anterolateral ligament abnormality. Arthroscopy 32(11):2331–2341CrossRefPubMed Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H (2016) Bone contusions after acute noncontact anterior cruciate ligament injury are associated with knee joint laxity, concomitant meniscal lesions, and anterolateral ligament abnormality. Arthroscopy 32(11):2331–2341CrossRefPubMed
31.
go back to reference Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H (2016) Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries. Am J Sports Med 44(2):362–369CrossRefPubMed Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H (2016) Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries. Am J Sports Med 44(2):362–369CrossRefPubMed
32.
go back to reference Speer KP, Spritzer CE, Bassett FH 3rd, Feagin JA Jr, Garrett WE Jr (1992) Osseous injury associated with acute tears of the anterior cruciate ligament. Am J Sports Med 20(4):382–389CrossRefPubMed Speer KP, Spritzer CE, Bassett FH 3rd, Feagin JA Jr, Garrett WE Jr (1992) Osseous injury associated with acute tears of the anterior cruciate ligament. Am J Sports Med 20(4):382–389CrossRefPubMed
33.
go back to reference Speer KP, Warren RF, Wickiewicz TL, Horowitz L, Henderson L (1995) Observations on the injury mechanism of anterior cruciate ligament tears in skiers. Am J Sports Med 23(1):77–81CrossRefPubMed Speer KP, Warren RF, Wickiewicz TL, Horowitz L, Henderson L (1995) Observations on the injury mechanism of anterior cruciate ligament tears in skiers. Am J Sports Med 23(1):77–81CrossRefPubMed
34.
go back to reference Sturnick DR, Vacek PM, DeSarno MJ, Gardner-Morse MG, Tourville TW, Slauterbeck JR, Johnson RJ, Shultz SJ, Beynnon BD (2015) Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females. Am J Sports Med 43(4):839–847PubMedPubMedCentralCrossRef Sturnick DR, Vacek PM, DeSarno MJ, Gardner-Morse MG, Tourville TW, Slauterbeck JR, Johnson RJ, Shultz SJ, Beynnon BD (2015) Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females. Am J Sports Med 43(4):839–847PubMedPubMedCentralCrossRef
35.
go back to reference Sturnick DR, Van Gorder R, Vacek PM, DeSarno MJ, Gardner-Morse MG, Tourville TW, Slauterbeck JR, Johnson RJ, Shultz SJ, Beynnon BD (2014) Tibial articular cartilage and meniscus geometries combine to influence female risk of anterior cruciate ligament injury. J Orthop Res 32(11):1487–1494PubMedPubMedCentralCrossRef Sturnick DR, Van Gorder R, Vacek PM, DeSarno MJ, Gardner-Morse MG, Tourville TW, Slauterbeck JR, Johnson RJ, Shultz SJ, Beynnon BD (2014) Tibial articular cartilage and meniscus geometries combine to influence female risk of anterior cruciate ligament injury. J Orthop Res 32(11):1487–1494PubMedPubMedCentralCrossRef
36.
go back to reference Szkopek K, Warming T, Neergaard K, Jorgensen HL, Christensen HE, Krogsgaard M (2012) Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture. Scand J Med Sci Sports 22(5):635–642CrossRefPubMed Szkopek K, Warming T, Neergaard K, Jorgensen HL, Christensen HE, Krogsgaard M (2012) Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture. Scand J Med Sci Sports 22(5):635–642CrossRefPubMed
37.
go back to reference Theologis AA, Kuo D, Cheng J, Bolbos RI, Carballido-Gamio J, Ma CB, Li X (2011) Evaluation of bone bruises and associated cartilage in anterior cruciate ligament-injured and -reconstructed knees using quantitative t(1rho) magnetic resonance imaging: 1-year cohort study. Arthroscopy 27(1):65–76CrossRefPubMed Theologis AA, Kuo D, Cheng J, Bolbos RI, Carballido-Gamio J, Ma CB, Li X (2011) Evaluation of bone bruises and associated cartilage in anterior cruciate ligament-injured and -reconstructed knees using quantitative t(1rho) magnetic resonance imaging: 1-year cohort study. Arthroscopy 27(1):65–76CrossRefPubMed
38.
go back to reference Wadhwa V, Omar H, Coyner K, Khazzam M, Robertson W, Chhabra A (2016) ISAKOS classification of meniscal tears-illustration on 2D and 3D isotropic spin echo MR imaging. Eur J Radiol 85(1):15–24CrossRefPubMed Wadhwa V, Omar H, Coyner K, Khazzam M, Robertson W, Chhabra A (2016) ISAKOS classification of meniscal tears-illustration on 2D and 3D isotropic spin echo MR imaging. Eur J Radiol 85(1):15–24CrossRefPubMed
39.
go back to reference Wordeman SC, Quatman CE, Kaeding CC, Hewett TE (2012) In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: a systematic review and meta-analysis. Am J Sports Med 40(7):1673–1681PubMedPubMedCentralCrossRef Wordeman SC, Quatman CE, Kaeding CC, Hewett TE (2012) In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: a systematic review and meta-analysis. Am J Sports Med 40(7):1673–1681PubMedPubMedCentralCrossRef
40.
go back to reference Yao L, Lee JK (1988) Occult intraosseous fracture: detection with MR imaging. Radiology 167(3):749–751CrossRefPubMed Yao L, Lee JK (1988) Occult intraosseous fracture: detection with MR imaging. Radiology 167(3):749–751CrossRefPubMed
Metadata
Title
Increased lateral meniscal slope is associated with greater incidence of lateral bone contusions in noncontact ACL injury
Authors
Ke Li
Jia Li
Xiaoqing Zheng
Vincent Marot
Jérôme Murgier
Etienne Cavaignac
Wei Huang
Publication date
01-06-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05724-8

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