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Delete 		PER-10 In certain embodiments, the bone engagement surface 2224 may include a cuneiform apposition portion 2226 and a metatarsal apposition portion 2228. As shown, the cuneiform apposition portion 2226 may be contoured to match the contour of the surface of the first cuneiform on which it is to rest, and the metatarsal apposition portion 2228 may similarly be contoured to match the contour of the surface of the first metatarsal on which it is to rest. (See FIG. 22C) Thus, the body 2210 may have only one stable position and orientation relative to the first cuneiform and the first metatarsal during a surgical osteotomy for correcting the condition. 248 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Next, a surgeon can resect a distal articular surface of the first cuneiform 210 and a proximal articular surface of the first metatarsal 230 by way of the second slot 1970 and the first slot 1960. After resection, the distal end of the first cuneiform 210 includes a planar cut surface and the proximal end of the first metatarsal 230 includes a planar cut surface. FIG. 20 illustrates that the bone engagement surface 1924 conforms to the surface of the two bones (e.g., first cuneiform 210 and first metatarsal 230). 236 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 FIG. 22D illustrates the cutting guide 2200 from a view facing the medial side 2216. FIG. 22E illustrates the cutting guide 2200 from a view facing the lateral side 2218. In certain embodiments, the cutting guide 2200 may include one or more features that facilitate use of the cutting guide 2200 while avoiding certain soft tissue in the vicinity of a joint. For example, the medial side 2216 may include a medial superior surface 2232 and a medial inferior surface 2234 that meet at a medial edge 2236. Advantageously, the medial inferior surface 2234 may extend from inferior side 2222 to the medial edge 2236 at an angle such that the medial inferior surface 2234 does not impinge soft tissue near the joint (e.g., near a medial end of the joint). In certain embodiments, the angle may range between about 80 and 170 degrees. In another example, the lateral side 2218 may include a lateral superior surface 2242 and a lateral inferior surface 2244 that meet at a lateral edge 2246 (See FIG. 22E). Of course, the medial superior surface 2232 may extend from the superior side 2220 to the medial edge 2236 at an angle. The angle of the medial superior surface 2232 may enable use of the cutting guide 2200 in tighter openings and thus minimize the size of incisions used for a procedure. 250 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Advantageously, the lateral inferior surface 2244 may extend from inferior side 2222 to the lateral edge 2246 at an angle such that the lateral inferior surface 2244 does not impinge soft tissue near the joint (e.g., near a medial end of the joint). In certain embodiments, the angle may range between about 80 and 170 degrees. Of course, the lateral superior surface 2242 may extend from the superior side 2220 to the lateral edge 2246 at an angle. The angle of the lateral superior surface 2242 may enable use of the cutting guide 2200 in tighter openings and thus minimize the size of incisions used for a procedure. 251 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 The body 2210 may further include guide features that guide a cutter to resect the first cuneiform and the first metatarsal 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, a burr, and/or the like. 252 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In the embodiment of Figures 22A through 22H, 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 and the first metatarsal. Various manual or powered tools may be used to form the planar cuts. In one embodiment, a sagittal bone saw can be used. In one example, the guide features may take the form of a first slot 2260 and a second slot 2270. The first slot 2260 may include a lateral end 2262 and a medial end 2264. The second slot 2270 may include a lateral end 2272 and a medial end 2274. 253 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In one embodiment, the first slot 2260 and the second slot 2270 extend from the superior side 2220 to the inferior side 2222. In certain embodiments, the first slot 2260 may extend from near the lateral side 2218 to near the medial side 2216. In other embodiments, one of, or both of, the first slot 2260 and the second slot 2270 may extend from one of the medial side 2216 or the lateral side 2218 of the body 2210. In certain embodiments, the first slot 2260 and second slot 2270 intersect. In other embodiments, the first slot 2260 and second slot 2270 do not intersect. 254 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Thus, upon desired positioning of the cutting guide 2200, the second slot 2270 may be positioned over at least a portion of the first cuneiform to facilitate resection of the first cuneiform, while the first slot 2260 may be positioned over at least a portion of the first metatarsal to facilitate resection of the first metatarsal. In one embodiment, the second slot 2270 is positioned near the distal end of the first cuneiform and the first slot 2260 is positioned near the proximal end of the first metatarsal. The first slot 2260 and second slot 2270 together, with the bone engagement surface 2224 overlying the first cuneiform and the first metatarsal, are positioned to guide resection of the first cuneiform and the first metatarsal during a surgical osteotomy for correcting a condition. 255 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In alternative embodiments, a guide feature may be designed to guide a different type of cutter, such as a drill, mill, or side-cutting burr. In such embodiments, the guide feature may not be a slot, but may instead be a translatable or rotatable cutter retainer that guides translation and/or rotation of the cutter relative to the bone. In certain embodiments, two or more guide features may be replaced by a single guide feature sized to permit a surgeon to resect both a first cuneiform and a first metatarsal using a single cutting guide 2200. 256 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Alternatively, or in addition, in certain embodiments, one or both of, the first guide feature and second guide feature may be positioned on, or in, the body 2210 and/or have an orientation based on patient imaging data. The patient imaging data can be used to position and orient one, or both, of the first guide feature and second guide feature such that formation of one, or both, of the first cut surface and the second cut surface and fixation of the two cut surfaces against each other mitigates a condition of the patient. For example, as described in the present disclosure, patient imaging data can be used to generate bone models of bones of the patient. The bone models can be used to determine and/or define contours for a bone engagement surface 2224, a position for a first slot 2260, an orientation for a first slot 2260, a position for a second slot 2270, an orientation for a second slot 2270, as well as other features and attributes of one or more patient specific instruments that can be used in a procedure. 258 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 FIG. 23 illustrates a perspective view of a first cuneiform and a first metatarsal with one embodiment of a patient-specific cutting guide positioned over a TMT joint. In the illustrated embodiment, the first guide feature may take the form of the first slot 2260 and the second guide feature may take the form of the second slot 2270. As with the embodiment of FIGS. 19A-19H and 20, the position and/or angles (e.g., orientation) of one or both of the guide features based on patient imaging data is illustrated. The first slot 2260 is oriented based on a desired angle for mitigating the condition of the patient. In one example, the first slot 2260 is angled perpendicular to a longitudinal axis 2276 of the first metatarsal 230. This orientation of the first slot 2260 enables the first cut surface to extend from the body 2210 toward the bone to form a cut surface that is also perpendicular to the longitudinal axis 2276 of one of the bones of a joint. 259 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In the illustrated embodiment, the second slot 2270 is positioned and oriented based on a desired angle for mitigating the condition of the patient. In the illustrated embodiment, the orientation of the second slot 2270 can be described in reference to a first angle A and a second angle B, just as those angles are described above in relation to FIG. 19D and 19H. 260 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Those of skill in the art will appreciate that the position and orientation of the first slot 2260 and second slot 2270 and the corresponding cut surface a surgeon can form using these guide features can vary depending on the anatomical structures of the patient, the osteotomy procedure being performed, preferences of the surgeon, the nature of the condition, and the like. 261 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Effective connection of the cutting guide 1900 to one or more bones across a joint can ensure that cut surfaces are formed in desired locations and orientation and mitigate removal of hard tissue and/or soft tissue outside in undesired locations. 224 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 Alternatively, or in addition, in certain embodiments, one or both of, the first guide feature and second guide feature may be positioned on, or in, the body 1910 and/or have an orientation based on patient imaging data. The patient imaging data can be used to position and orient one, or both, of the first guide feature and second guide feature such that formation of one, or both, of the first cut surface and the second cut surface and fixation of the two cut surfaces against each other mitigates a condition of the patient. For example, as described in the present disclosure, patient imaging data can be used to generate bone models of bones of the patient. The bone models can be used to determine and/or define contours for a bone engagement surface 1924, a position for a first slot 1960, an orientation for a first slot 1960, a position for a second slot 1970, an orientation for a second slot 1970, as well as other features and attributes of one or more patient specific instruments that can be used in a procedure. 212 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 "Cut surface" refers to a surface of an object that is created or formed by the removal of one or more parts of the object that includes the original surface. Cut surfaces can be created using a variety of methods, tools, or apparatuses and may be formed using a variety of removal actions, including, but not limited to, fenestrating, drilling, abrading, cutting, sawing, chiseling, digging, scrapping, and the like. Tools and/or methods used for forming a cut surface can include manual, mechanical, motorized, hydraulic, automated, robotic, and the like. In certain embodiments, the cut surface(s) are planar. 213 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 "Orientation" refers to a direction, angle, position, condition, state, or configuration of a first object, component, part, apparatus, system, or assembly relative to another object, component, part, apparatus, system, assembly, reference point, reference axis, or reference plane. 214 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 FIG. 20 illustrates one embodiment of the cutting guide 1900 secured to a first metatarsal 230 and a first cuneiform 210. In the illustrated embodiment, the first guide feature may take the form of the first slot 1960 and the second guide feature may take the form of the second slot 1970. Referring now to FIGS. 20 and 19D, the position and/or angles (e.g., orientation) of one or both of the guide features based on patient imaging data is illustrated. In the illustrated embodiment, the first slot 1960 is positioned between the distal side 1914 and the second slot 1970. The first slot 1960 is oriented based on a desired angle for mitigating the condition of the patient. In one example, the first slot 1960 is angled perpendicular to a longitudinal axis of the first metatarsal 230. This orientation of the first slot 1960 enables the first cut surface to extend from the body 1910 toward the bone to form a cut surface that is also perpendicular to the longitudinal axis 1976 of one of the bones of a joint. "Longitudinal axis" refers to an axis of a structure, device, object, apparatus, or part thereof that extends from one end of a longest dimension to an opposite end. Typically, a longitudinal axis passes through a center of the structure, device, object, apparatus, or part thereof along the longitudinal axis. The center point used for the longitudinal axis may be a geometric center point and/or a mass center point. In the illustrated embodiment, the longitudinal axis 1976 is the longitudinal axis of the first metatarsal 230. 215 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 In the illustrated embodiment, the second slot 1970 is positioned between the proximal side 1912 and the first slot 1960. In addition in the illustrated embodiment, the second slot 1970 is oriented based on a desired angle for mitigating the condition of the patient. In the illustrated embodiment, the orientation of the second slot 1970 can be described in reference to a first angle A and a second angle B. FIG. 19D illustrates first angle A. In one embodiment, a second cut surface formed by resection using second slot 1970 extends inferiorly away from a first cut surface formed by resection using first slot 1960. Described another way, angle A is an angle between a first plane 1978 that includes the first slot 1960 and a first cut surface formed by resection using first slot 1960 and a second plane that includes the second slot 1970 and a second cut surface formed by resection using second slot 1970, the second plane extending from the first plane toward the proximal side 1912 of the body 1910. In certain embodiments, angle A can range between about 4 degrees to about 18 degrees. In certain embodiments, angle A may start at 0 degrees and then increase to a positive number of degrees as illustrated or decrease to a negative number of degrees depending on how a surgeon may prescribe adjustments for a correction. 216 Added by DJM 2 2022 2/25/22, 12:00 AM
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Delete 		PER-10 FIG. 19H illustrates second angle B. In one embodiment, a second cut surface formed by resection using second slot 1970 extends posteriorly away from a first cut surface formed by resection using first slot 1960. Described another way, in the illustrated embodiment, angle B is an angle between the first plane 1978 that includes the first slot 1960 and a first cut surface formed by resection using first slot 1960 and a third plane 1981 that includes the second slot 1970 and a second cut surface formed by resection using second slot 1970, the third plane 1981 extending from the first plane toward the proximal side 1912 of the body 1910. In certain embodiments, angle B can range between about 0 degrees to about 35 degrees. In certain embodiments, angle B may start at 0 degrees and then increase to a positive number of degrees as illustrated or decrease to a negative number of degrees depending on how a surgeon may prescribe adjustments for a correction. 217 Added by DJM 2 2022 2/25/22, 12:00 AM

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