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Delete 		PER-4 DIV1 Like the cuneiform apposition portion 342 and the metatarsus apposition portion 344 of the cutting guide 300, generation of the contours of the cuneiform apposition portion 742 and the metatarsus apposition portion 744 may be performed relative easily in various CAD programs through surface copy operations, Boolean operations, and/or the like. 52 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 The first metatarsus 230 may be secured to the first cuneiform 210, at least until proper bone in-growth has occurred between the first cuneiform 210 and the first metatarsus 230. In some embodiments, a bone plate (not shown) or other fastener (not shown) may be used to secure the first cuneiform 210 and the first metatarsus 230 together. Additional hardware (not shown) may be used to stabilize the position and/or orientation of the first proximal phalanx 600 relative to the first metatarsus 230, if desired. The surgical wound may be closed, and the foot 200 may be allowed to heal with the bunion deformity corrected. 43 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 Figures 6B and 6C are dorsal views of the foot 200, before and after correction, respectively. Figures 6B and 6C illustrate the correction of the angulation of the first metatarsus 230, by which the distal end 250 of the first metatarsus 230 is moved in the lateral direction 260. In some embodiments, an implant 610 may be inserted in the space between the first metatarsus 230 and the first cuneiform 210 in order hold the first metatarsus 230 and the first cuneiform 210 together and/or facilitate bony fusion between the first metatarsus 230 and the first cuneiform 210. 44 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 In some embodiments, the implant 610 may be patient-specific. For example, the implant 610 may have a cuneiform-facing side 620 that is shaped and/or sized to be secured to the adjoining, resected surface of the first cuneiform 210, and a metatarsus-facing side 630 that is shaped and/or sized to be secured to the adjoining, resected surface of the first metatarsus 230. As the resections made to the first metatarsus 230 and the first cuneiform 210 may both planar, the cuneiform-facing side 620 and/or the metatarsus-facing side 630 may also be planar. However, the cuneiform-facing side 620 and/or the metatarsus-facing side 630 may advantageously each be shaped to match the profile of the resected surface of the first cuneiform 210 and the first metatarsus 230, respectively. 45 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 This shaping may be accomplished by custom-designing the implant 610 for the patient, using the same models (for example, from CT scans) of the first metatarsus 230 and the first cuneiform 210 that were used to generate the cutting guide 300. Thus, the implant 610 may have a shape that provides secure attachment and/or fusion between the first metatarsus 230 and the first cuneiform 210 while avoiding proud edges or other protruding features that could otherwise interfere with surrounding tissues. 46 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 As indicated previously, the cutting guide 300 is only one of many patient-specific instruments that may be used in connection with the method 100 and/or the method 120. An alternative cutting guide suitable for use with the method 120 will be shown and described in connection with Figures 7A, 7B, 7C, and 7D. 47 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 Figures 7A, 7B, 7C, and 7D are top perspective, alternative top perspective, front elevation, and bottom perspective views, respectively, of a patient-specific cutting guide, or cutting guide 700, according to one alternative embodiment. The cutting guide 700 may be used to correct a bunion deformity, such as that of the foot 200 of Figure 2. Thus, the cutting guide 700 may also be designed to facilitate resection of the first cuneiform 210 and the first metatarsus 230 with planar cuts at the proper angles to provide dual-plane correction of the orientation of the first metatarsus 230, thereby providing correction in the lateral direction 260 and in the plantar direction 280 or the dorsal direction 290. 48 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 As shown, the cutting guide 700 may have a body 710 with a monolithic construction and the general shape of a rectangular prism. The cutting guide 700 may further have a joint alignment feature that helps align the body 710 with the metatarsocuneiform joint between the first cuneiform 210 and the first metatarsus 230. The joint alignment feature may consist of a joint probe 720 that extends from the body 710 and has a blade-like shape. The body 710 may reside on the dorsal surfaces of the first cuneiform 210 and the first metatarsus 230, while the joint probe 720 may protrude into the metatarsocuneiform joint between the first cuneiform 210 and the first metatarsus 230 to provide proper alignment of the body 710 with the metatarsocuneiform joint. Notably, the joint probe 720 may have surfaces that are not simply planar, but rather have some contouring by which the shape of the joint probe 720 is matched to the adjoining surfaces of the first cuneiform 210 and/or the first metatarsus 230. Such contouring of the joint probe 720 may enable more precise alignment of the body 710 with the metatarsocuneiform joint. 49 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 The body 710 may have a bone apposition side 730 that, upon attachment of the body 710 to the first cuneiform 210 and the first metatarsus 230, is to face toward the first cuneiform 210 and the first metatarsus 230. The body 710 may also have an outward-facing side 732 that, upon attachment of the body 710 to the first cuneiform 210 and the first metatarsus 230, faces outward, away from the first cuneiform 210 and the first metatarsus 230. Further, the body 710 may have one or more bone attachment features that facilitate attachment of the body 710 to the first cuneiform 210 and/or the first metatarsus 230. Such bone attachment features may comprise any of a wide variety of holes, spikes, fastening devices, and/or the like. As embodied in Figures 7A through 7D, the bone attachment features may take the form of holes 740 that extend from the bone apposition side 330 to the outward-facing side 332. The holes 340 may be shaped to accommodate pins, K-wires, and/or other elongated bone fixation elements that can be anchored in the first cuneiform 210 and/or the first metatarsus 230 to keep the cutting guide 700 in place. As embodied in Figures 7A through 7D, only one hole 340 may be present on each side of the body 710. Thus, the body 710 may be secured to the first cuneiform 210 with only a single pin or K-wire (not shown) and to the first metatarsus 230 with only another single pin or K-wire (not shown). 50 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 The bone apposition side 730 may be custom contoured to match the shapes of the first cuneiform 210 and/or the first metatarsus 230. As embodied in Figures 7A through 7D, the bone apposition side 730 may have a cuneiform apposition portion 742 shaped to lie against the dorsal surface of the first cuneiform 210, and a metatarsus apposition portion 744 shaped to lie against the dorsal surface of the first metatarsus 230. As shown, the cuneiform apposition portion 742 may be contoured to match the contour of the dorsal surface of the first cuneiform 210 on which it is to rest, and the metatarsus apposition portion 744 may similarly be contoured to match the contour of the dorsal surface of the first metatarsus 230 on which it is to rest. Thus, the body 710 may have only one stable position and orientation relative to the first cuneiform 210 and the first metatarsus 230. 51 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 The cut between the first bone segment 1040 and the second bone segment 1042 may be carried out virtually (for example, in CAD) on a model of the calcaneus 1000 obtained from a CT scan or other imaging of the patient’s foot. Thus, the optimal realignment of the posterior end of the calcaneus 1000 can be obtained. If desired, a patient-specific cutting guide, or cutting guide 1043, may be generated in order to facilitate resection of the calcaneus 1000. 63 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 The body 710 may further have guide features that guide a cutter to resect the first cuneiform 210 and the first metatarsus 230 in the manner needed to make the desired correction. For example, the guide features may be used to guide a planar cutting blade, an arcuate cutting blade, a drill or mill, and/or the like. 53 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 In the embodiment of Figures 7A through 7D, the guide features may guide a reciprocating planar blade, such as that of a surgical bone saw, that forms planar cuts in the first cuneiform 210 and the first metatarsus 230. Thus, the guide features may take the form of a first slot 750 and a second slot 752, which may be positioned toward the center of the body 710, on opposite sides of the joint probe 720. Thus, upon proper positioning of the cutting guide 700, the first slot 750 may be positioned over the first cuneiform 210 to facilitate resection of the first cuneiform 210, while the second slot 752 may be positioned over the first metatarsus 230 to facilitate resection of the first metatarsus 230. 54 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 In operation, the cutting guide 700 may be used in a manner similar to that of the cutting guide 300. However, the cutting guide 700 may only be secured to each of the first cuneiform 210 and the first metatarsus 230 with a single pin or K-wire (not shown), as mentioned previously. Further, the cutting guide 700 is smaller than the cutting guide 300. Thus, the cutting guide 700 may be placed through a smaller, less invasive incision. One advantage to patient-specific instrumentation may be that instruments may be made smaller, since they are not limited to certain sizes. Many known instruments come in discrete sizes, each of which is designed to accommodate a range of patient anatomic dimensions. Thus, for given patient anatomy, the instrument must be large enough to treat the anatomy at either end of its range. This typically requires the instrument to be oversized for many anatomic dimensions it is designed to treat. Notably, the cutting guide 700 is merely one compact example; other cutting guides may be made even smaller; in some embodiments, cutting guides may be made that have a smaller width between holes (e.g., holes 740 on the cutting guide 700). As long as the holes are sufficiently far apart to avoid interference of the pins 500 with the operation of the cutting blade, the cutting guide may function appropriately. Thus, Lapidus and other procedures may be accomplished through a very narrow incision through the use of patient-specific instrumentation. 55 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 Those of skill in the art will recognize that a wide variety of differently configured cutting guides may be used in conjunction with the method 120 set forth above. Further, a wide variety of patient-specific instruments may be used in connection with the method 100, including but not limited to cutting guides, gages, implant positioning guides, joint distractors, joint compressors, soft tissue retractors, and the like. 56 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 Furthermore, patient-specific cutting guides may be used for various other procedures on the foot, or on other bones of the musculoskeletal system. Patient-specific cutting guides may be used for various procedures involving osteotomy, including but not limited to arthroplasty, fusion, and deformity correction procedures. According to one example, patient-specific cutting guides similar to the cutting guide 300 and the cutting guide 700 may be used for the metatarsophalangeal (“MTP”) joint. A method similar to the method 100 may be employed. 57 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 In some embodiments, one or more articulating surfaces of a joint may be replaced and/or resurfaced. For example, for the MTP joint, a patient-specific cutting guide may be used to determine the angles of cuts on the distal metatarsus or the proximal phalanx in preparation for replacement or resurfacing of the metatarsal head and/or the proximal phalangeal base. Implants for either the metatarsus or the phalanx may be customized to match the patient’s original anatomy, such as the curvature of the MTP joint. In other embodiments, an MTP joint may be fused through the use of patient-specific cutting guides. Patient-specific cutting guides may be used to treat (for example, via fusion, resurfacing, and/or arthroplasty) any joint in the body, using methods similar to the method 100. 58 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 According to other examples, patient-specific cutting guides may be used to carry out an Evans calcaneal osteotomy and/or a medializing calcaneal osteotomy. Patient-specific instruments will be shown and described in connection with Figures 8A through 11, in relation to an Evans calcaneal osteotomy, and a medializing calcaneal osteotomy. 59 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 Figures 8A, 8B, and 8C are dorsal pre-operative, dorsal post-operative, and lateral post-operative views, respectively, of a foot treated with an Evans calcaneal osteotomy, according to one embodiment. Outward rotation of the foot may occur in patients with flatfoot. An Evans or lateral column lengthening procedure is sometimes performed for these patients. An incision is made on the outside of the foot, and the front half of the heel bone is cut. A bone wedge (typically either titanium or a bone-based graft) is then placed into the cut area of the heel bone. This wedge helps to “lengthen” the heel bone and rotate the foot back into its correct position. The wedge is usually kept in place using screws or a surgical staple. 60 Added by DJM Jan 2024 1/6/24, 9:54 PM
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Delete 		PER-4 DIV1 Figures 9A and 9B are dorsal post-operative and lateral post-operative views, respectively, of a foot treated with a medializing calcaneal osteotomy, according to one embodiment. A medializing calcaneal osteotomy (heel slide) procedure is often used when the calcaneus (heel bone) has shifted out from underneath the leg. An incision is made on the outside of the heel, and the back half of the heel bone is cut and slid back underneath the leg. The heel is then fixed in place using metal screws or a plate. This also helps to reposition the Achilles tendon towards the center of the ankle/rearfoot. The medializing calcaneal osteotomy can be used in place of, or in addition to, an Evans calcaneal osteotomy. 61 Added by DJM Jan 2024 1/6/24, 9:54 PM

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