Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Application	Content	Paragraph Number	Notes	Modified
		Content		Paragraph Number	Notes	Any Field
View Edit Delete	PER-33	Next, a surgeon may place the tendon trajectory guide 1120 on the target location, aligning a center axis of the opening 1134 with the inferior target marker 1108 location on the navicular 218. FIG. 12C illustrates the tendon trajectory guide 1120 positioned on the navicular 218 by way of seating the tendon trajectory guide 1120 on the plantar surface of the navicular 218. Advantageously, the bone engagement surface 1126 engages the surface of the navicular 218 to register the tendon trajectory guide 1120 in the desired location. In certain embodiments, the tendon trajectory guide 1120 may include landmark registration features that can facilitate positioning the tendon trajectory guide 1120 in the desired position. In one embodiment, the tendon trajectory guide 1120 may be referred to as a pin guide.	340	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	The tendon deployment system 1000 may include a handle 922 that can couple to the tendon trajectory guide 1120 by way of a coupler 958. In one embodiment, external threads of the handle 922 may engage internal threads of the coupler 958 to connect the handle 922 to the tendon trajectory guide 1120. The handle 922 can serve to facilitate positioning, placement, registration, and/or removal of the tendon trajectory guide 1120 during one or more stages of a procedure.	341	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 1134 and into the navicular 218. The fastener 910 may pass through the opening 1134 into the navicular 218 and out the opposite side. Advantageously, the positioned tendon trajectory guide 1120 ensures that the distal end of the fastener 910 exits the cortical bone at the superior target marker 1110.	342	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 having an eyelet 912. The fastener 910 may be supplied with the tendon trajectory guide 1120 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 1120 by sliding the tendon trajectory guide 1120 off of the fastener 910.	343	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	With the tendon trajectory guide 1120 and fastener 910 in place, the surgeon can next remove the tendon trajectory guide 1120 and leave the fastener 910 in place. 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. Next, the surgeon may follow traditional steps to attach a tendon (e.g., the FDL tendon) to the attachment point and along a trajectory provided by the tendon trajectory guide 1120 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 FDL 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 dorsal (distal) opening on the superior surface of the navicular 218. In this manner, the FDL is threaded into the bone tunnel. The FDL may then be secured and/or fixated in the bone tunnel using conventional techniques and/or implants and/or fasteners.	344	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	A patient may present with a variety of conditions. To correct or mitigate these conditions, a tendon trajectory guide 1120 according to the present disclosure can be used to address dorsiflexion, plantar flexion, angular correction of a bone segment or any bone, flat foot, club foot, or a variety of foot, hand, or joint conditions. Those of skill in the art will appreciate that the tendon trajectory guide 1120 may also include bone engagement features, resection features, or the like depending on the needs of a surgeon for a particular surgical procedure.	345	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	For example, FIG. 11C illustrates an embodiment of a tendon trajectory guide 1120 that includes a bone engagement feature 1128. The bone engagement feature 1128 extends from a body of the tendon trajectory guide 1120 dorsally along a medial side of the navicular 218. In certain embodiments, the initial dimensions of the bone engagement feature 1128 may be set by a technician working with a model of the tendon trajectory guide 1120 and bone models of bones such as the navicular 218 of a patient. However, before the tendon trajectory guide 1120 a surgical procedure is performed using the tendon trajectory guide 1120 a surgeon reviews the design of the tendon trajectory guide 1120 and can revised or adjust the configuration of the bone engagement feature 1128. In this manner, the surgeon remains in control and makes the determination as to what the final design of the tendon trajectory guide 1120 should be. A surgeon can for example, request that the bone engagement feature 1128 extend less dorsally and/or extend more anteriorly, etc. The surgeon may have many reasons for making these adjustments. However, the benefit of the present disclosure is that the design of the tendon trajectory guide 1120 can be revised by the surgeon until the design matches the surgeon’s needs and/or preferences for the surgical procedure.	346	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In the illustrated embodiment, the bone engagement feature 1128 can also include a bone engagement surface 1126 on a surface that contacts and/or faces a surface of the navicular 218. Alternatively, or in addition, the bone engagement feature 1128 can include one or more landmark registration features 1124 that can further assist a surgeon in positioning the tendon trajectory guide 1120 during a surgical procedure.	347	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 number, size, shape, and/or other configuration aspects of a bone engagement feature 1128, in certain embodiments, can be directly proportional to a landmark configuration of a bone indicated on a bone model of one or more bones of a patient. This means, in certain embodiments, for example, that where a surface and/or area of bone includes three landmarks with a particular relationship between them, the tendon trajectory guide 1120 can include three corresponding bone engagement features 1128.	348	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	FIGs. 12A-12E illustrate different views of one embodiment of a tendon trajectory guide 1120 for the navicular 218. The tendon trajectory guide 1120 includes a body 1134 having an anterior side 1136, a posterior side 1138, a medial side 1140, a lateral side 1142, a superior side 1144, and an inferior side 1146. The tendon trajectory guide 1120 includes a bone engagement surface 1126 and opening 1134. In certain embodiments, the tendon trajectory guide 1120 may include one or more landmark registration features 1124.	349	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	A landmark registration feature 1124 can be any structure of the tendon trajectory guide 1120 that engages with, is configured to engage with, contacts and/or connects to a landmark of a bone. In the illustrated embodiment, the landmark registration feature 1124 is a lip that is configured to engage with a bone process that extends from and/or shapes the bone (e.g., navicular 218). Advantageously, a surgeon can request additional landmark registration features 1124 and/or can modify one or more landmark registration feature 1124 such that they are larger or smaller, according to their own needs and/or preferences for the surgical procedure.	350	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Additionally, a surgeon may use one or more components in an exemplary system 700 to make multiple cuts, openings, and/or bone tunnels in the bone(s). The multiple cuts may be centered over or around an apex of a deformity or positioned at other locations within the foot such that when the multiple cuts are made, any resected segments removed, bone tunnels formed, or added bone void fillers introduced, and/or bones and/or bone fragments translated and/or rotated the combined angles, surfaces, removed segments, and/or added portions cooperate to provide a desired correction. Each of the components of the exemplary system 700 can be identified, defined, and reviewed using the apparatuses, systems, and/or methods of the present disclosure.	259	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In certain embodiments, the components of system 700 may be made as small as possible to minimize the amount of soft tissue that is opened in the patient for the procedure. Alternatively, or in addition, walls and/or sides of the components may be beveled and/or angled to avoid contact with other hard tissue or soft tissues in the operating field for the procedure.	260	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 for certain procedures a complementary component 730 may not be needed or a given complementary component 730 may be optional for use in the procedure. Similarly, those of skill in the art will appreciate that certain features of the fasteners 710, STRGs 720, and/or complementary components 730 can be combined into one or more of apparatus or devices or may be provided using a plurality of separate devices.	261	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	FIG. 8 illustrates an exemplary soft tissue rearrangement system 800, according to one embodiment. The soft tissue rearrangement system 800 can include one or more fasteners 710 embodied in for the form of depicted exemplary fastener 910, one or more STRGs 720 embodied in for the form of depicted exemplary bone tunnel guide 920, and zero or one or more complementary components 730. The bone tunnel guide 920 may also include one or more trajectory ports 722, one or more optional landmark registration features 724, and/or one or more optional bone engagement features 726. (See FIG. 7) In certain embodiments, a bone engagement feature 928 can include one or more bone engagement surfaces.	262	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	While specific embodiments of complementary components 730 are not specifically shown here in relation to the system 800, those of skill in the art will appreciate that complementary components 730 can be similar in feature, design, implementation, configuration, and purpose as those described in relation to the system 700 and can be used for the soft tissue rearrangement system 800. Thus, the soft tissue rearrangement system 800 can include one or more alignment guides 732, rotation guides 734, reduction guides 736, compression guides 738, positioning guides 740, fixation guides 742, navigation guides 744, implants 746, or the like.	263	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	The bone tunnel guide 920 may be a custom patient-specific soft tissue rearrangement guide made for a particular patient and/or for a particular surgical procedure. Various aspects of the bone tunnel guide 920 may be patient-specific, including, but not limited to, an angle and/or orientation for a trajectory port 924 of the bone tunnel guide 920, a position of the trajectory port 924, a depth of the trajectory port 924, a size and/or geometric configuration of the trajectory port 924, a size of the bone tunnel guide 920, a configuration, design, and/or composition of a bone contacting structure such as a bone engagement feature 928 of the bone tunnel guide 920, a number of bone engagement features 928, a position of the bone tunnel guide 920 relative to one or more bones of a patient, a position, orientation, configuration and/or existence of an optional handle 922, and the like.	264	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In one embodiment, the bone tunnel guide 920 includes a body 932 that includes a superior side 934, an inferior side 936, a medial side 938, a lateral side 940, a posterior side 942, and an anterior side 944. Generally, the sides of the bone tunnel guide 920 refer to the direction the sides face when the bone tunnel guide 920 is in use.	265	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In certain embodiments, a position, configuration, and/or orientation of the trajectory port 924 can be determined and/or defined at least partially based on a bone model of at least a portion of a bone of a patient's foot. The trajectory port 924 extends through the body 932. In one embodiment, the trajectory port 924 may be positioned to guide a tool for forming a bone tunnel in a bone of a patient for a surgical procedure such as a deformity correction. The bone model may be defined and/or determined based at least in part on medical imaging of the bone of the patient.	266	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In one embodiment, the position and/or configuration of the trajectory port 924 may be determined, defined, and/or dictated at least in part by both a bone model of a portion of a patient's foot and user instructions 604. Advantageously, the user instructions 604 may identify certain goals for the bone tunnel guide 920 such as minimal size (i.e., width, length, depth), shape, contour, position, orientation, trajectory, and the like. Since the bone tunnel guide 920 guides the formation of bone tunnel, the configuration of the bone tunnel guide 920 provided by the user instructions 604 can also define an osteotomy or bone tunnel created using the bone tunnel guide 920.	267	Added by DJM Jan 2024	1/6/24, 9:58 PM

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