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Delete 		PER-16 In certain embodiments, the amount of pivot or rotation permitted for the cutter guide 1010 can be predefined, can be set for all pivoting resection guides 1002, can be patient matched for a patients having certain characteristics (e.g., age, gender, condition), and/or can be patient-specific. In certain embodiments, the range of pivot angle permitted for the cutter guide 1010 can be between about 30 degrees and about 50 degrees. 299 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Specifically, the mechanical advantage is defined as the length of the lever arm divided by the length of the load arm. The mechanical advantage provides a magnitude for how much the effort force is multiplied. In a first-class lever configuration, the force on the load is equal to the effort force multiplied by the length of the lever arm (the distance between where the effort force is applied perpendicular to the lever arm and the fulcrum). This is the principle of torque. Thus, in general, the longer the lever arm the greater the force applied to the load with the same level of effort force. The present disclosure uses the benefits of a first-class lever. Of course, other embodiments may implement a second-class or third-class lever to facilitate applying a force to a load. 308 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 Applying an effort force to the lever arm creates a moment or torque about the fulcrum equal to the magnitude of the force multiplied by the length of the lever arm (e.g., the distance from where the effort force is applied along the lever arm to the fulcrum). The lever arm and effort force create a mechanical advantage at the point that the load arm encounters the load. 307 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 A fulcrum is a point or structure about which a lever pivots or rotates. The length of the lever arm is the distance from where the effort force is applied to the fulcrum. The length of the load arm is the distance from the fulcrum to where the load arm encounters the load. A fulcrum is a pivot point or pivot axis of the lever that converts an effort force applied perpendicular to the lever arm into a load force perpendicular to the load where the load arm contacts the load. 306 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The lever arm receives or encounters an effort force, and the load arm receives or encounters a load. Traditionally, the rigid structure is a planar structure, however, the rigid structure can also be a cylindrical structure that may or may not have an opening that extends the length of and through the center of the cylindrical structure. The lever arm is the part of the rigid structure that accepts or receives an effort force applied to the lever arm to operate the lever. The load arm is the part of the rigid structure that accepts, receives, or acts against a load. A load force is a force created by the load arm in response to the effort force applied to the lever arm. 305 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In a first-class lever, the lever arm and load arm are on opposite ends of a rigid structure and the fulcrum engages with, and enables, the rigid structure to pivot or rotate about an axis transverse to the rigid structure and positioned at the fulcrum. The fulcrum is between the load arm and the lever arm. 304 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 "First-class Lever" refers to a type of lever. A lever is a simple machine that includes a fulcrum, a lever arm, and a load arm. In the embodiment of FIG. 13A, the cutter guide 1010, pivot axis 1014, and first bone attachment feature 1006 and/or second bone attachment feature 1008 can serve as the fulcrum. 303 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The first-class lever includes the cutting tool 1026, the cutter guide 1010, and either the handle 1004 in combination with a driver (not shown) of the cutting tool 1026 or just the driver. In the illustrated embodiment, the handle 1004 passes the cutting tool 1026 through the opening 1214 and couples (e.g., handle coupler 1212) to the cutter guide 1010 to form the first-class lever. Alternatively, or in addition, the driver of the cutting tool 1026 may be coupled to the cutting tool 1026 and the cutting section 1222 passed through the cutter guide 1010 and together with the driver, cutting tool 1026, and cutter guide 1010 form a first-class lever. In either case, the first bone attachment feature 1006 and second bone attachment feature 1008 cooperate with the first coupler 1118 and the second coupler 1148 to provide a fulcrum for the first-class lever. The fulcrum includes the pivot axis 1014. 302 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 13A is a side view of the pivoting resection guide 1002, according to one embodiment, in one pivot position. Advantageously, the cutter guide 1010 is configured to pivot about a pivot axis 1014 that runs transverse to a longitudinal axis 1302 of the cutter guide 1010. In the illustrated embodiment, the step 104 is perpendicular to the longitudinal axis 1302. The pivoting resection guide 1002 is configured to provide a first-class lever for a surgeon to use to make accurate and precise osteotomies of one or more bones. 301 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In certain embodiments, the pivoting resection guide 1002 may be custom designed such that the distance the pivoting resection guide 1002 can be rotated about pivot axis 1014 is controlled/limited/predefined or restricted. Advantageously, this rotational limit may be a patient-specific limit to the rotation or pivot of the pivoting resection guide 1002. Advantageously, the rotational limit can help a surgeon to resect only where desired and no further. 300 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In the illustrated embodiment, the cutting tool 1026, cutter guide 1010, driver, and optionally the handle 1004 cooperate to provide the rigid structure of the first-class lever. The lever arm 1306 is the distance between the pivot axis 1014 and where an effort force (FE) is applied to the lever. The distance of the lever arm 1306 has a measurable length. The load arm 1308 is the distance between the pivot axis 1014 and where a load force (FL) is applied to the load (e.g., the bone 1304). The distance of the load arm 1308 has a measurable length. Generally, the FL will be a point where the cutting section 1222 contacts the bone 1304. As the cutting section 1222 encounters more bone material the FL may move more distally. The bone 1304 contacts the cutting tool 1026 near the distal end 1204 of the cutting tool 1026. 309 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In certain embodiments, the pivoting resection guide 1002 includes one or more stops referred to as rotational stops. These one or more stops serve to stop, prevent, slow, or hinder rotational movement of the cutter guide 1010 about the pivot axis 1014. Those of skill in the art will appreciate that implementations of the one or more stops can take a variety of forms. Referring to FIG. 12B, in one example, one or more of the proximal arm 1230 and the other distal arm 1238 can be configured to include one or more tabs 1252 in addition, one or more of the openings 1226, 1228 can be configured to such that an arm that includes a tab 1252 is capable of rotating with the cutter guide 1010 about the pivot axis 1014 through a set range of angles but no further. For example, the openings 1226, 1228 may include a cross section that is semi-circular on one side and then angle to interfere with one or more of the tabs 1252 as the distal arm 1238 and/or proximal arm 1230 rotates within the openings 1226, 1228. Those of skill in the art will appreciate that tabs 1252 is but one example of how one of skill in the art may implement a stop to manage a range or arc of pivot that the cutter guide 1010 can guide a cutting tool 1026 through. 298 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In certain embodiments, the handle coupler 1212 may also include at least one arm 1250. The arm 1250 may extend radially from the handle 1004 near a distal handle end 1208 of the handle 1004. The arm 1250 is configured to engage with one or the other of the first bone attachment feature 1006 and the second bone attachment feature 1008. For example, in the illustrated embodiment, the handle 1004 includes a first arm 1250a extending from one side and a second arm 1250b extending from an opposite side. The arm 1250 are configured to seat and/or rotate with a recess 1018 (See FIGs. 14A, 14B) in a superior side 1104 of the first bone attachment feature 1006 and/or a superior side 1134 of the second bone attachment feature 1008. The recesses may be shaped to receive the arms 1250a, 1250b that extend from the handle 1004 to engage the handle 1004 when coupled to the cutter guide 1010. Those of skill in the art will appreciate that the pivoting resection guide 1002 can be used with or without a handle 1004. Where a handle 1004 is not used, the user may pivot a cutting tool 1026 using a driver of the cutting tool 1026, which may include a handle of its own. In such an embodiment, the driver may serve the same or a similar function to the handle 1004 described in embodiments herein. 297 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 FIG. 12B is an exploded view of a handle 1004 and a cutter guide 1010, according to one embodiment. FIG. 12B illustrates one implementation of a handle coupler 1212. The handle coupler 1212 can include a recess 1246 that extends from a distal handle end 1208 towards the proximal handle end 1210. In certain embodiments, the recess 1246 is concentric with the opening 1214 of the handle 1004. In certain embodiments, the recess 1246 has a cross section that is the same or complimentary to a proximal end 1248 of the cutter guide 1010. In the illustrated embodiment, the recess 1246 having a cross-sectional shape and size configured to accept the proximal end 1248 of the cutter guide 1010 into the recess 1246. 296 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 As described herein, the first coupler 1118 and/or second coupler 1148 are, or can be, configured to retain a pivot arm, also referred to as an arm of the cutter guide 1010. The first coupler 1118 and second coupler 1148 retain the pivot arms to keep the cutter guide 1010 stable and positioned at a desired position between the first bone attachment feature 1006 and the second bone attachment feature 1008. Advantageously, the first coupler 1118 and second coupler 1148 also enable the cutter guide 1010 to rotate about at least one pivot arm. In certain embodiments, one of the couplers (e.g., first coupler 1118 and/or second coupler 1148) may retain a single pivot arm of a cutter guide 1010 and enable the cutter guide 1010 to rotate about that single pivot arm. 295 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The distal arm retainer 1242 provides interference within the distal arm groove 1240 such that the distal arm 1238 is retained within the opening 1228. Of course, a set screw is but one example of a suitable distal arm retainer 1242. In one embodiment, the distal arm retainer 1242 is a thumbscrew, which may enable a user to readily release a distal arm 1238 so that the cutter guide 1010 can be swapped with another one. The distal arm retainer 1242 may also be a pin, a screw, a bolt, or the like. In the illustrated embodiment, the second arm angle 1244 is a right angle such that the longitudinal axis of the cutter guide 1010 is parallel to the proximal side 1142 of the second bone attachment feature 1008. Those of skill in the art will appreciate that the second arm angle 1244 can be a variety of angles and can be patient-specific such that the trajectory 1124 of the cutter guide 1010 can be predetermined based, at least in part on the second arm angle 1244. 294 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The distal arm groove 1240 may be toward a distal end of the distal arm 1238. The distal arm groove 1240 circumscribes the distal arm 1238 and cooperates with the distal arm retainer 1242 to retain the distal arm 1238 within the opening 1228. In the illustrated embodiment, the distal arm retainer 1242 is a set screw that passes through an opening in the body 1132 of the second bone attachment feature 1008 and extends into the distal arm groove 1240. The distal arm retainer 1242 engages the body 1132 of the second bone attachment feature 1008 and the distal arm groove 1240 to couple the distal arm 1238 to the second bone attachment feature 1008. 293 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 In the illustrated embodiment, the second coupler 1148 in one embodiment, includes a distal arm 1238, a distal arm groove 1240, and a distal arm retainer 1242. The distal arm 1238 extends from a second side of the cutter guide 1010 at a second arm angle 1244 towards the second bone attachment feature 1008. In the illustrated embodiment, the distal arm 1238 is a cylindrical structure that extends from the cutter guide 1010. The opening 1228 is also circular which allows the distal arm 1238 to rotate within the opening 1228. 292 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The proximal arm retainer 1234 provides interference within the proximal arm groove 1232 such that the proximal arm 1230 is retained within the opening 1226. Of course, a set screw is but one example of a suitable proximal arm retainer 1234. In one embodiment, the proximal arm retainer 1234 is a thumbscrew, which may enable a user to readily release a proximal arm 1230 so that the cutter guide 1010 can be swapped with another one. The proximal arm retainer 1234 may also be a pin, a screw, a bolt, or the like. In the illustrated embodiment, the first arm angle 1236 is a right angle such that the longitudinal axis of the cutter guide 1010 is parallel to the distal side 1114 of the first bone attachment feature 1006. Those of skill in the art will appreciate that the first arm angle 1236 can be a variety of angles and can be patient-specific such that the trajectory 1124 of the cutter guide 1010 can be predetermined based, at least in part on the first arm angle 1236. 291 Added by DJM Jan 2024 1/3/24, 4:26 AM
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Delete 		PER-16 The proximal arm groove 1232 may be toward a distal end of the proximal arm 1230. The proximal arm groove 1232 circumscribes the proximal arm 1230 and cooperates with the proximal arm retainer 1234 to retain the proximal arm 1230 within the opening 1226. In the illustrated embodiment, the proximal arm retainer 1234 is a set screw that passes through an opening in the body 1102 of the first bone attachment feature 1006 and extends into the proximal arm groove 1232. The proximal arm retainer 1234 engages the body 1102 of the first bone attachment feature 1006 and the proximal arm groove 1232 to couple the proximal arm 1230 to the first bone attachment feature 1006. 290 Added by DJM Jan 2024 1/3/24, 4:26 AM

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