Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-33	In another embodiment, the tendon trajectory guide 920 can be used for a Jones tenosuspension in which an extensor hallucis tendon is transferred from a phalanx of a hallux and transferred to the first metatarsal neck to address a mallet toe condition or cavus foot condition.	320	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 used to transfer an extensor digitorum longus (EDL) from toes of a patient to the midfoot and attach to the lateral cuneiform or intermediate cuneiform to address a cavus foot condition or a claw toe condition.	321	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 used for an extensor hallucis longus (EHL) transfer to address a ruptured tibialis anterior tendon (TAT). In this procedure, one or more tendons connected to the interphalangeal joint (IPJ) of the hallux (big toe) are transferred to the medial cuneiform to address a dropfoot condition.	322	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 used to transfer a tibialis anterior tendon (TAT) to the calcaneus to address a congenital calcaneal valgus condition.	323	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 used to relocate an Achilles tendon from an original attachment point on the calcaneus to a new attachment point on the calcaneus.	324	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 apparatuses, systems, and methods of the present disclosure can be used other surgical procedure guides beyond tendon trajectory guides and/or resection guides. For example, the apparatuses, systems, and methods of the present disclosure can be used to provide targeting guides that are patient-specific and which can be used in a variety of surgical procedures. For example, the apparatuses, systems, and methods of the present disclosure can be used to provide a targeting guide for deltoid ligament reconstruction and/or for lateral collateral ankle ligament reconstruction.	325	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In such embodiments, the targeting guide can be used to facilitate positioning of bone tunnels and/or attachment points for an allograft and/or a tendon and/or ligament anchoring system in the sustentaculum tali of the calcaneus, talus, and/or medial malleoli.	326	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Furthermore, in such embodiments, the targeting guide can be used to facilitate positioning of bone tunnels and/or attachment points for lateral ankle ligament reconstruction for attachment points for an allograft and/or a tendon and/or ligament anchoring system for the anterior talo-fibular ligament (ATFL) and/or the calcaneofibular ligament (CFL) for the calcaneus, talus, and/or fibula.	327	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Furthermore, in such embodiments, the targeting guide can be used to facilitate positioning of bone tunnels and/or attachment points for constructs and/or ligaments for a plantar calcaneonavicular ligament (“spring ligament”) repair of the navicular and/or talus.	328	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In yet another example, the tendon trajectory guide 920 can be used for a flexor digitorum longus (FDL) transfer in which the FDL tendon is transferred from its normal attachment point to attach to an inferior side of the navicular 218. Transfer of the FDL tendon to the navicular 218 can be used to address a flat foot condition or when the posterior tibial tendon (PTT) is not performing properly.	329	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	FIG. 11A illustrates an inferior perspective view of a foot and ankle including the medial cuneiform 202, intermediate cuneiform 204, lateral cuneiform 206, first metatarsal 208, second metatarsal 210, third metatarsal 212, fourth metatarsal 214, fifth metatarsal 216, navicular 218, cuboid 220, calcaneus 224, a tibia 226, and talus 222. FIG. 11A also illustrates the three-dimensional axis 1000. The three-dimensional axis 1000 includes the cephalad-caudal axis 1002, the medial-lateral axis 1004, and the anterior-posterior axis 1006.	330	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Generally, in a tendon deployment a surgeon seeks to position the tendon in an optimal location on, or in, a bone to provide improved mobility and use of an extremity. For example, in an FDL tendon transfer, a surgeon plans to position a resected end of an FDL tendon on a plantar/inferior surface of a navicular 218. In one embodiment, a surgeon may plan to position the FDL tendon approximately where an inferior target marker 1108 is illustrated in FIG. 11A. The inferior target marker 1108 indicates where a surgeon desires the attachment point to be for a deployed tendon (e.g., either a transferred tendon or attachment of another tendon or graft).	331	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Conventionally, a surgeon may determine the attachment point represented by the inferior target marker 1108 intraoperatively and may rely on various techniques including x-rays, fluoroscopy, and the like. However, determining an optimal location for inferior target marker 1108 can be a challenge.	332	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	If the location (e.g., inferior target marker 1108) is too far medial or too far lateral along medial-lateral axis 1004 this can lead to complications and problems later for the patient. If the location (e.g., inferior target marker 1108) is too far anterior or too far posterior along anterior-posterior axis 1006 this can lead to complications.	333	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Advantageously, the tendon trajectory guide 1120 facilitates locating and positioning the deployed tendon at an attachment point indicated by the inferior target marker 1108 with each tendon deployment procedure. As explained above, the tendon trajectory guide 1120 can be positioned, sized, configured, and oriented and/or trajectories set for the tendon trajectory guide 1120 preoperatively using bone models. Additionally, a surgeon can provide a prescription for the location of the attachment point (e.g., inferior target marker 1108) to account for other conditions of a particular patient.	334	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In addition, the bone engagement surface 1126 of the tendon trajectory guide 1120 is defined to match and correspond to the surface contour and/or any landmarks on a surface of the bone, such as the navicular 218. This means that once the plantar surface of the navicular 218 is exposed a surgeon can seat the tendon trajectory guide 1120 in the same location and position and orientation as used preoperatively. Advantageously, the bone engagement surface 1126 matches to the surface of the navicular 218 and/or any landmarks of the navicular 218 such that the surgeon can position the bone engagement surface 1126 on the inferior target marker 1108 accurately each time and in each procedure. Once the bone engagement surface 1126 is registered to the plantar surface of the navicular 218 the surgeon is assured that deployment of a hole, opening, bone tunnel, or fastener 910 through the trajectory port will match the location / trajectory determine preoperatively. Thus, many of the challenges of determining the inferior target marker 1108 are overcome using the tendon trajectory guide 1120.	335	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	FIG. 11B illustrates a superior perspective view of a foot and ankle including the tibia 226, fibula 228, talus 222, and navicular 218. FIG. 11B illustrates an exit point indicated in FIG. 11B by a superior target marker 1110 that identifies where a trajectory set by the tendon trajectory guide 1120 (See FIG. 11C) will cause a pin, drill bit, or cutting tool to exit cortical bone of the navicular 218 opposite the inferior target marker 1108.	336	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	The position of the inferior target marker 1108 and the trajectory set by the trajectory port of the tendon trajectory guide 1120 determine the location of the superior target marker 1110. Surgeons may have a specific set of instructions and/or a prescription for the location of the superior target marker 1110. Multiple factors can influence the location of the superior target marker 1110 and the trajectory.	337	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	FIGS. 11C illustrates a stage of performing a tendon placement procedure (e.g., an FDL tendon transfer to the navicular 218) using the tendon deployment system 1000, according to one embodiment. Typically, the initial approach for a tendon placement procedure, such as an FDL tendon transfer to the navicular 218 is on the inferior side of the foot and the navicular 218. FIGs. 11A and 11B illustrate where a surgeon has indicated the location for the attachment point, the inferior target marker 1108 and the superior target marker 1110 and the desired trajectory.	338	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Referring to FIG. 11C, during an exemplary tendon placement procedure, such as an FDL tendon transfer to the navicular 218, an initial step, is to expose the plantar surface of the navicular 218.	339	Added by DJM Jan 2024	1/6/24, 9:58 PM

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