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Delete 		PER-33 In one embodiment, the position and/or configuration of the trajectory port 1324 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 tendon trajectory guide 1320 such as minimal size (i.e., width, length, depth), shape, contour, position, orientation, trajectory, and the like. Since the tendon trajectory guide 1320 guides the formation of bone tunnel, the configuration of the tendon trajectory guide 1320 provided by the user instructions 604 can also define an osteotomy or bone tunnel created using the tendon trajectory guide 1320. 360 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In certain embodiments, a user, or end user, may review the bone model, and a model of the tendon trajectory guide 1320 and based on these models determine, at least in part, where to position and/or orient a trajectory port 1324 within a tendon trajectory guide 1320. Advantageously, determining a position and/or orientation for the trajectory port 1324 in a model of an instrument can be directly reflected in a fabricated instrument based on the model. In one embodiment, the position and/or orientation for the trajectory port 1324 can be based on user instructions 604. Alternatively, or in addition, other features of a trajectory port 1324 can be based, at least partially, on user instructions 604. Alternatively, or in addition, in one embodiment, features of a tendon trajectory guide 1320 can be based on accepted practice aspects for a particular surgical procedure. 361 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 FIGs. 14A and 14B illustrate views of a tendon trajectory guide 1320 of the system of FIG. 13, according to one embodiment. The tendon trajectory guide 1320 includes at least one trajectory port 1324. 362 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In the illustrated embodiment, the tendon trajectory guide 1320 includes three bone engagement features 1328a, 1328b, 1328c. Other embodiments may not include a bone engagement feature 1328. In certain embodiments, one or more of the bone engagement features 1328 may include a bone engagement surface 1346. Alternatively, or in addition, the tendon trajectory guide 1320 may include a bone engagement surface 1346. Alternatively, or in addition, the tendon trajectory guide 1320 may also include one or more bone attachment features (not shown). 363 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In certain embodiments, the tendon trajectory guide 1320 includes a bone engagement surface 1346 on an inferior side 1336 of the body 1332. The bone engagement surface 1346 is configured to engage a surface of a foot bone such that the bone engagement surface 1346 positions the tendon trajectory guide 1320 at a desired position on the foot bone. The desired position can be determined, predetermined, and/or prescribed by a surgeon. 364 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 The trajectory port 1324 extends through the body 1332. In one embodiment, the trajectory port 1324 includes an opening 1348 that extends from a top surface of the trajectory port 1324 through to a bottom surface of the trajectory port 1324. The trajectory port 1324 serves to guide a surgeon and indicates a desired trajectory for a temporary fastener, a cutting tool, or other instrumentation a surgeon may use for deploying a tendon, tendon substitute, tendon anchor, soft tissue, a graft, or the like. In one embodiment, the trajectory port 1324 is configured to guide a tool for forming a bone tunnel in a foot bone of a patient. The trajectory port 1324 can be defined at least partially based on a bone model of at least a portion of the foot bone. The bone model may be based on medical imaging of the foot bone of the patient. 365 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In the illustrated embodiment, of FIG. 14A and 14B, the trajectory port 1324 includes a port body 1350. The port body 1350 extends away from the body 1332. In certain embodiments, the port body 1350 has a length that enables a user to grasp the port body 1350 to secure the tendon trajectory guide 1320 in place for formation of a bone tunnel by way of the trajectory port 1324. In such an embodiment, the tendon trajectory guide 1320 may not include a separate handle that is connectable to a internally threaded opening in the tendon trajectory guide 1320. 366 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 Referring to FIGs. 13, 14A, and 14B, the soft tissue rearrangement system 1300 can serve to guide formation of a bone tunnel or passage for a variety of procedures. In one embodiment, the soft tissue rearrangement system 1300 may be configured specifically as a tendon transfer system for tendon deployment to remediate a bone condition present in a patient’s foot. The soft tissue rearrangement system 1300 includes a fastener 710. 367 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In one embodiment, the fastener 710 can serve as a guide for forming a bone tunnel or passage in bone and as an inserter 1352. The inserter 1352 includes a proximal end 1354, a distal end 1356, and an elongated body 1358 between the proximal end 1354 the distal end 1356. The distal end 1356 includes a point 1360 and the proximal end 1354 includes an opening 1362. 368 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 A user may position the tendon trajectory guide 1320 in a desired location on a bone for formation of bone tunnel. The bone tunnel can cooperate with an anchor to anchor soft tissue within the bone tunnel. The user may deploy the inserter 1352 to serve as a guide for a cannulated drill bit to form the bone tunnel. Once the bone tunnel is formed having two open ends, the user can use the inserter 1352 to insert a tendon, a free end of a tendon, a graft, or the like through the bone tunnel. In one example, a user may pass an end of a tendon and/or graft through the opening 1362 and may secure the tendon and/or graft to the inserter 1352. Next, a user may thread the inserter 1352 through the bone tunnel. The user may then tension the tendon and/or graft to desired tension and anchor the tendon and/or graft to the tunnel. 369 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In the illustrated embodiment, the soft tissue rearrangement system 1300 includes a tendon trajectory guide 1320 configured to permit a user to grasp the port body 1350 to hold the tendon trajectory guide 1320 in place as the bone tunnel is formed and/or as an inserter 1352 or fastener 710 is deployed to facilitate forming the bone tunnel. This embodiment is illustrated in FIG. 13. 370 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 Those of skill in the art will appreciate that in certain embodiments, the tendon trajectory guide 1320 can include an integrated handle such as a port body 1350. Or the soft tissue rearrangement system 1300 can include a handle for the tendon trajectory guide 1320. The handle 922 of system 1000 is one example of a handle that can be used with such an embodiment. FIG. 15B illustrates another example. The handle can include a first coupler configured to removably engage a second coupler of the tendon trajectory guide 1320. For example, the first coupler can be external threads on an end of the handle and the second coupler can be internal threads in an opening in a body 1332 of the tendon trajectory guide 1320. 371 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 FIGs. 15A-15B illustrate dorsal perspective views of a foot including a tendon trajectory guide, according to an alternative embodiment. FIG. 15A illustrates one embodiment of a tendon trajectory guide 1320 in which the port body 1350 serves as a handle for using the tendon trajectory guide 1320. FIG. 15B illustrates an alternative embodiment in which the body 1332 of the tendon trajectory guide 1320 includes a coupler for coupling to a coupler of a separate handle 922. The embodiments of FIGs 15A and 15B may have many structures, features, and functions, operations, and configuration similar or identical to those of the soft tissue rearrangement system 1300 described in relation to FIG. 13, like parts are identified with the same reference numerals. The embodiment of the tendon trajectory guide 1320 of FIG. 15A is illustrated in FIGs. 16A-16C. 372 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 FIGs. 15A-15B a lateral cuneiform 206 as the desired location for securing a tendon for a particular tendon transfer procedure. For example, a surgeon may desire to perform a posterior tibial tendon transfer surgical procedure. Advantageously, the tendon trajectory guide 1320 of FIGs 15A and 15B provide examples of patient-specific tendon transfer guides suitable, and/or specifically designed, to assist a surgeon in performing this procedure. 373 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In the illustrated embodiment, the tendon trajectory guides 1320 include a plurality of appendages 1502. The plurality of appendages 1502 may extend laterally from the body 1332. Advantageously, a surgeon can determine and/or provide instructions for how many appendages 1502 to include and/or what landmarks one or more appendages 1502 are to register to during the surgical procedure. 374 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In one embodiment, the appendage 1502 can be an implementation of a bone engagement features 1328. Alternatively, or in addition, an appendage 1502 may include more or fewer aspects as a bone engagement feature 1328. In the embodiment of FIG. 15B, the tendon trajectory guide 1320b can include a structure that extends for engaging with the handle 922. This structure may be a bone engagement feature 1328, a landmark registration feature, an appendage, any combination of these, and/or neither of these. 375 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 FIGs. 16A-16C illustrate views of a tendon trajectory guide of FIG. 15A, according to one embodiment. FIG. 16A is an anterior-medial view of the lateral cuneiform 206 with a tendon trajectory guide 1320a positioned on its dorsal surface. It should be noted that the appendages 1502, in this embodiment, are configured to wrap around a medial, anterior, and lateral end of the lateral cuneiform 206 and extend into three of the joints of the lateral cuneiform 206. By including three appendages 1502, a surgeon can be assured that the tendon trajectory guide 1320a is positioned in a desired position determined preoperatively. In one embodiment, a surgeon determines the desired position. FIG. 16B is a posterior-lateral view of the lateral cuneiform 206 with the tendon trajectory guide 1320a positioned on its dorsal surface. 376 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 FIG. 16C illustrates an inferior side 1336 of the tendon trajectory guide 1320a. The bone engagement surface 1346 is illustrated. In certain embodiments, each appendage 1502 can include an appendage inferior surface 1504. In the illustrated embodiment, the appendage inferior surface 1504 includes a bone engagement surface 1506 on the appendage inferior surface 1504. In certain embodiments, the appendage inferior surface 1504 can be implementations of a landmark registration feature and/or a bone engagement feature. 377 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In the illustrated embodiment, at least one appendage 1502 extends from the body 1332. Advantageously, the appendage 1502 can provide a surgeon with confidence and assurance in the placement and positioning of the tendon trajectory guide 1320 on the bone because the appendage 1502 can be configured to engage with a particular landmark on the bone (e.g., a side surface of the bone (dorsal, plantar, medial, lateral, a projection or a depression or cavity, one or more joints, or the like). Alternatively, or in addition, the appendage 1502 can include a contoured bone engagement surface 1506 that can further facilitate registration of the appendage 1502 and/or tendon trajectory guide 1320 with the bone. In this manner, a surgeon can be assured intraoperatively that the tendon trajectory guide 1320 is being positioned as desired. 378 Added by DJM Jan 2024 1/6/24, 9:58 PM
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Delete 		PER-33 In certain embodiments, the appendage 1502 can be shaped like a hook to engage a surface or structure of a bone. Alternatively, or in addition, the tendon trajectory guide 1320 may include an appendage 1502 on each side, together the appendage 1502 can engage one or more landmarks of the bone such that the surgeon can accurately position and register the tendon trajectory guide 1320 to the bone. 379 Added by DJM Jan 2024 1/6/24, 9:58 PM

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