Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-33	Advantageously, the tendon trajectory guide 920 facilitates locating and positioning the deployed tendon at an attachment point indicated by the superior target marker 1008 with each tendon deployment procedure. The tendon trajectory guide 920 ensures that the attachment point is centered along the medial-lateral axis 1004 between the medial and lateral sides of the calcaneus 224.	300	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	As explained above, the tendon trajectory guide 920 can be positioned, sized, configured, and oriented and/or trajectories set for the tendon trajectory guide 920 preoperatively using bone models. Additionally, a surgeon can provide a prescription for the location of the attachment point (e.g., superior target marker 1008) to account for other conditions of a particular patient such as bone spurs on the plantar surface of the calcaneus 224.	301	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In addition, the bone engagement surface 946 of the tendon trajectory guide 920 is defined to match and correspond to the surface contour and/or landmarks on a dorsal surface of the bone, such as the calcaneus 224. This means that once the dorsal surface of the calcaneus 224 is exposed a surgeon can seat the tendon trajectory guide 920 in the same location and position and orientation as used preoperatively in models. Advantageously, the bone engagement surface 946 matches to the surface of the calcaneus 224 and/or any landmarks of the calcaneus 224 such that the surgeon can position the tendon trajectory guide 920 on the superior target marker 1008 each time and in each procedure. Such consistency can improve patient care.	302	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Alternatively, or in addition, a surgeon may save time in the operating room because an imaging machine such as a C-arm may not be needed to check positioning and/or trajectory before the surgical procedure proceeds. Once the tendon trajectory guide 920 is registered to the dorsal surface of the calcaneus 224 the surgeon is assured that deployment of a hole, opening, bone tunnel, or fastener 910 through the trajectory port 924 will match a location / trajectory determine preoperatively. Thus, many of the challenges of determining the superior target marker 1008 are overcome using the tendon trajectory guide 920.	303	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	FIG. 10B illustrates an inferior perspective view of a foot and ankle including the calcaneus 224, a tibia 226, fibula 228, talus 222, and navicular 218. FIG. 10B illustrates an exit point indicated in FIG. 10B by an inferior target marker 1010 that identifies where a trajectory set by the tendon trajectory guide 920 will cause a pin, drill bit, or cutting tool to exit cortical bone of the calcaneus 224 opposite the superior target marker 1008.	304	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	The position of the superior target marker 1008 and the trajectory set by the trajectory port 924 of the tendon trajectory guide 920 determine the location of the inferior target marker 1010. Surgeons may have a specific set of instructions and/or a prescription for the location of the inferior target marker 1010. Multiple factors can influence the location of the inferior target marker 1010 and the trajectory. In one embodiment, the surgeon wants to position the inferior target marker 1010 a millimeter, or so, anterior (along anterior-posterior axis 1006) to two posterior tuberosities 1012 on the plantar side of the calcaneus 224. These tuberosities can serve as landmarks for designing and fabricating the tendon trajectory guide 920. If the inferior target marker 1010 is too far posterior, along anterior-posterior axis 1006, the lever arm of the FHL may be impacted. If the inferior target marker 1010 is too far anterior, along anterior-posterior axis 1006, the exit point may interfere with arteries and/or nerves on the plantar side of the foot. In certain embodiments, a patient may have a bone spur near the tuberosities 1012, in such a case, a surgeon may provide instructions to position the inferior target marker 1010 anterior to the bone spur.	305	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	FIGS. 10C-10D illustrate different stages of performing a tendon placement procedure (e.g., an FHL tendon transfer) using the soft tissue rearrangement system 800, according to one embodiment. Typically, the initial approach for a tendon placement procedure, such as an FHL tendon transfer is on the posterior side of the foot and the calcaneus 224. FIGs. 10A and 10B illustrate where a surgeon has indicated the location for the attachment point, the superior target marker 1008 and the inferior target marker 1010 and the desired trajectory.	306	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Referring to FIG. 10C, during an exemplary tendon placement procedure, such as an FHL tendon transfer, an initial step, using a posterior approach, may be to cut through, or to resect, the Achilles tendon proximal to the calcaneus 224. Next, facia between the Achilles tendon and the distal end of the fibula 228 and tibia 226 may be dissected and released to reveal the FHL tendon and posterior aspect of the calcaneus 224.	307	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In certain techniques, or methods of use, a surgeon may want to resect a bursal projection 223 (or tuberosity) on the posterosuperior corner of the calcaneus 224. This can be done in a few ways.	308	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In one embodiment, a surgeon may place the tendon trajectory guide 920 on the target location, aligning a center axis of the opening 948 with the superior target marker 1008 location on the calcaneus 224. FIG. 10C illustrates the tendon trajectory guide 920 positioned on the calcaneus 224 by way of seating the tendon trajectory guide 920 on the dorsal surface of the calcaneus 224. Advantageously, the bone engagement surface 946 engages the surface of the calcaneus 224 to register the tendon trajectory guide 920 in the desired location. In certain embodiments, the bone engagement features 928 can facilitate positioning the tendon trajectory guide 920 in the desired position. In one embodiment, the tendon trajectory guide 920 may be referred to as a pin guide.	309	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	The soft tissue rearrangement system 800 may include a handle 922 coupled to the tendon trajectory guide 920. In one embodiment, external threads of the handle 922 may engage internal threads of a handle coupler to connect the handle 922 to the tendon trajectory guide 920. The handle 922 can serve to facilitate positioning, placement, registration, and/or removal of the tendon trajectory guide 920 during one or more stages of a procedure.	310	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Next, a surgeon may deploy a fastener 910 through the opening 948 and into the calcaneus 224. This stage is shown in FIG. 10D, the fastener 910 passes through the opening 948 into the calcaneus 224 and out the opposite side. Advantageously, the positioned tendon trajectory guide 920 and the trajectory of the trajectory port 922 ensures that the distal end of the fastener 910 exits the cortical bone at the inferior target marker 1010.	311	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In one embodiment, the fastener 910 is an eyelet pin that includes an eye 912. The fastener 910 may be supplied with the tendon trajectory guide 920 and/or may be supplied in a conventional tendon transfer surgical system/kit/tray. With the fastener 910 deployed, the surgeon may then remove the tendon trajectory guide 920 by sliding it off of the fastener 910.	312	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Next, in certain embodiments, a surgeon may remove the fastener 910 and then resect the bursal projection 223. After resection, the removed fastener 910 leaves a hole in the calcaneus 224 that can be used to redeploy the fastener 910 into the hole in the same location and trajectory. The fastener 910 in the same hole can then be used to guide a reamer over the fastener 910 to form a bone tunnel coaxial with the fastener 910. Alternatively, or in addition, a surgeon may use the hole formed by the fastener 910 to form a bone tunnel coaxial using other techniques.	313	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Alternatively, or in addition, with the tendon trajectory guide 920 and fastener 910 in place, the surgeon can next remove the tendon trajectory guide 920 and leave the fastener 910 in place. Next, the surgeon may resect the bursal projection 223 all around the fastener 910. The method may then proceed with the surgeon reaming a bone tunnel around the fastener 910 such that the bone tunnel is coaxial with the fastener 910.	314	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Next, the surgeon may follow traditional steps to attach a tendon to the attachment point and along a trajectory provided by the tendon trajectory guide 920 using a variety of conventional tendon transfer kits/systems/instruments or the like. For example, a surgeon may thread a suture that is whip stitched to an end of the FHL and pass the suture through a proximal eyelet of the fastener 910. Next, the surgeon may press the fastener 910 through the bone tunnel and out the plantar (distal) opening on the inferior surface of the calcaneus 224. In this manner, the FHL is threaded into the bone tunnel. The FHL may then be secured and/or fixated in the bone tunnel using conventional techniques and/or implants and/or fasteners.	315	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Those of skill in the art will appreciate that the tendon trajectory guide 920 can be used for a variety of tendon attachment/positioning procedures in hindfoot, midfoot, forefoot, hand, wrist, elbow, shoulder, and/or the like. Furthermore, patient-specific guides such as the exemplary tendon trajectory guide 920 can be used for attaching a tendon or ligament to a bone in a variety of ways, a variety of surgical procedures and/or to accommodate a variety surgeon preferences or instructions. For example, with an FDL transfer, a surgeon may decide to attach the tendon medially and drill a blind hole using a guide such as the tendon trajectory guide 920. One skilled in the art can appreciate that the presented embodiments may be modified, revised, or repositioned to address a surgeon’s particular angles, approach, entry locations and/or preferences.	316	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In another example, embodiments of the tendon trajectory guide 920 can be used for ax axial tendon transfer in which a posterior tibial tendon (aka tibialis posterior tendon) is rerouted from attachment to the navicular 218 to pass between the tibia 226 and fibula 228 down the dorsal side of the midfoot and attached to the lateral cuneiform 206. In such a procedure, the tendon trajectory guide 920 can seat on the lateral cuneiform 206 to identify the attachment point and/or trajectory for a fixation system.	317	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	As another example, a tendon trajectory guide 920 can be used for a tibialis anterior tendon transfer in which the tibialis anterior tendon (TAT) is transferred from the inside medial cuneiform 202 and reattached to either the lateral cuneiform 206 or the cuboid 220. In such a procedure, the tendon trajectory guide 920 can seat on either the lateral cuneiform 206, the cuboid 220 or both to identify the attachment point and/or trajectory for a fixation system. This procedure can be used to address club foot conditions and flat foot conditions.	318	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In another embodiment, the tendon trajectory guide 920 can be a posterior tibial tendon transfer guide used for a surgical procedure to transfer the attachment point from navicular and relocate the tendon through the leg to the intermediate or lateral cuneiform to address a dropfoot condition.	319	Added by DJM Jan 2024	1/6/24, 9:58 PM

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