Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	PER-33	The bone tunnel guide 920 can be fabricated using additive manufacturing, subtractive manufacturing, molding, casting, or the like. The bone tunnel guide 920 can be made from a variety of materials such as, but not limited to, polymers (e.g., polyimide (nylon) polymers, Nylene®), metal (e.g., titanium, titanium alloys, stainless-steel, stainless-steel alloys, nickel-titanium alloys), ceramic, biocompatible materials, or the like. In certain embodiments, a material is selected that will reduce the cost for the bone tunnel guide 920.	283	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In certain embodiments, a number of bone engagement features 928 (e.g., 928a, 928b, 928c?) of the plurality of bone engagement features 928 may be directly proportional to a number of landmark configurations near, or at, a modeled position of a bone tunnel guide model engaging a bone model of a bone, or a portion of a bone, of a patient. For example, suppose a user provides medical imaging that is used to generate a model of one or more bones of a patient and a model of a bone tunnel guide 920 that could be used.	284	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	A user may review an initial design of the bone tunnel guide 920 and a model of the bone that will receive the bone tunnel for a surgical procedure. The user may identify four distinct landmark configurations on, at, or near where a bone tunnel is planned for the surgical procedure. Accordingly, the surgeon/user may provide user instructions 604 that four bone engagement features 928 be included in a bone tunnel guide 920 for the surgical procedure. Each of the four-bone engagement features 928 may be specifically designed and/or engineered to engage with each of the four landmark configurations. In one embodiment, one of the landmark configurations may be a bony surface; another landmark configuration may be a joint; landmark configurations may be a bone distal to a joint; another landmark configurations may be a different part of a bone surface. In this example, the number of landmark configurations (four) is directly proportional to the number of bone engagement features 928 (four).	285	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Once a technician or engineer designs a model of the bone tunnel guide 920 together with one or more models of bones of a patient, the technician may send the designed model to the user or otherwise make the design available for review by the user/surgeon. A surgeon can review the model and/or the one or more modeled bones, and/or manipulate them in an interface to visualize where the model of the bone tunnel guide 920 will register to one or more bones and thus where a resulting bone tunnel can be formed in one or more bones.	286	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Based on this review, the surgeon may have further changes and/or adjustments to the model of the bone tunnel guide 920 based on patient anatomy, steps for a planned surgical procedure, and/or surgeon preferences. With this feedback from the surgeon, the technician may make further adjustments and/or changes to the designed model of the bone tunnel guide. This process of review and revision can be repeated multiple times until the surgeon approves the design. At this point the technician can arrange for the model of the bone tunnel guide to be fabricated to create the bone tunnel guide 920. The bone tunnel guide 920 is then provided to the user for use in a surgical procedure.	287	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 plurality of bone engagement features 928 that each extend away from the trajectory port 924. For example, the bone engagement features 928 can extend from one or more sides of the bone tunnel guide 920. In one embodiment, the plurality of bone engagement features 928 may extend away from the trajectory port 924 radially in different directions.	288	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In the illustrated embodiment, the bone engagement features 928 extend from opposite sides of the bone tunnel guide 920. Those of skill in the art will appreciate that the bone engagement features 928 can have various lengths, widths, and thicknesses. Furthermore, these configurations attributes of the bone engagement feature 928 may be patient-specific. Advantageously, the bone engagement features 928 also include a bone engagement surface 946 that may extend a bone engagement surface 946 on an inferior surface (inferior side 936) of the bone tunnel guide 920.	289	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In the illustrated embodiment, one bone engagement feature 928a extends from the lateral side 940 and one bone engagement feature 928 extends from the medial side 938. Advantageously, the bone engagement feature 928 can provide a surgeon with confidence and assurance in the placement and positioning of the bone tunnel guide 920 on the bone because one or more of the bone engagement features 928 can be configured to engage with one or more particular landmarks on the bone (e.g., a projection, an eminence, a bone spur, a depression, a cavity, or the like). Alternatively, or in addition, the bone engagement feature 928 can include a contoured bone engagement surface 946 that can further facilitate registration of the bone engagement feature 928 and/or bone tunnel guide 920 with the bone. In this manner, a surgeon can be assured intraoperatively that the bone tunnel guide 920 is being positioned in accordance with a preoperative plan.	290	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In certain embodiments, the bone engagement feature 928 can be shaped like a hook, a finger, a foot, an arm, a leg, or an appendage, to engage a dorsal/medial surface of bone or dorsal/lateral surface of bone. Alternatively, or in addition, the bone tunnel guide 920 may include a bone engagement feature 928 on each side (medial and lateral), together the bone engagement features 928 can engage one or more landmarks of the bone such that the surgeon can accurately position and register the bone tunnel guide 920 to the bone.	291	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Referring to FIGs 9A, 9B, and 9E, in one embodiment, the bone tunnel guide 920 includes a handle 922 and the body 932 includes a handle coupler 950. In the illustrated embodiment, the handle 922 is configured to secure the bone tunnel guide 920 in place during formation of a bone tunnel by way of the trajectory port 924. Those of skill in the art will appreciate that the trajectory port 924 can be used to form a bone tunnel in a variety of ways, each of which is within the scope of the present disclosure. For example, in one embodiment, a user may deploy a fastener 910 such as K-wire or a fastener 910 that includes an eye 912. After deploying the fastener 910, a user may use a cannulated drill bit to drill out bone around the fastener 910 and thereby form a bone tunnel that is coaxial with the fastener 910. In one embodiment, the user may thread a suture through the eye 912 of the fastener 910 and use the fastener 910 to pass the suture through the newly formed bone tunnel. Alternatively, or in addition, a user may use the bone tunnel guide 920 and trajectory port 924 to guide a drill bit or burr that is passed through the trajectory port 924 and into the bone to form a bone tunnel in the bone. Advantageously, a user can hold the bone tunnel guide 920 in place using the handle 922 as steps are taken to form a bone tunnel having substantially the same trajectory and/or orientation as the trajectory port 924.	292	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	The handle 922 includes shaft 952 that includes a proximal end 954 and a distal end 956. The distal end 956 includes a coupler 958. In one embodiment, the coupler 958 includes external threads 960 configured to engage with internal threads 962 of the handle coupler 950 formed in the body 932. In one embodiment, the coupler 958 is configured to be removable such that a coupler 958 of a different size or having a different coupling can be used with the same handle 922.	293	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In the illustrated embodiment, the handle coupler 950 is closer to the anterior side 944 of the bone tunnel guide 920 and the bone engagement features 928 extend from the medial side 938 and lateral side 940. Those of skill in the art will appreciate that the handle coupler 950 may be in another position in the bone tunnel guide 920 and that the bone engagement features 928 may extend from sides other than those in the illustrated embodiment.	294	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	FIG. 10A illustrates a superior perspective view of a foot and ankle including the calcaneus 224, a tibia 226, fibula 228, talus 222, and navicular 218. FIG. 10A also illustrates a three-dimensional axis 1000. The three-dimensional axis 1000 includes a cephalad-caudal axis 1002, a medial-lateral axis 1004, and an anterior-posterior axis 1006.	295	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	Generally, in a soft tissue rearrangement such as a tendon deployment surgical procedure 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 a Flexor Hallucis Longus (FHL) tendon transfer, a surgeon plans to position a relocated end of an FHL tendon on a dorsal surface of a calcaneus 224, centered along the medial-lateral axis 1004. In one embodiment, a surgeon may plan to position the FHL tendon approximately where a superior target marker 1008 is illustrated in FIG. 10A. The superior target marker 1008 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).	296	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 superior target marker 1008 intraoperatively and may rely on various techniques including x-rays, fluoroscopy, and the like. However, determining an optimal location for superior target marker 1008 can be a challenge. Even using X-rays, such as a C-arm, offer very little help to a surgeon since the C-arm can only provide a limited view given the angle at which the X-ray can be taken of the dorsal side of the calcaneus 224.	297	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	If the location (e.g., superior target marker 1008) is too far medial or too far lateral along medial-lateral axis 1004 this can lead to complications and problems later for the patient, such as gait problems and/or subtalar arthritis, and the like. If the location (e.g., superior target marker 1008) is too far anterior or too far posterior along anterior-posterior axis 1006 this can lead to contact and/or disruption of plantar nerves, vessels, disconnecting of bone spurs on a plantar surface, and/or other neurovascular constructs on the plantar side of the calcaneus 224.	298	Added by DJM Jan 2024	1/6/24, 9:58 PM
View Edit Delete	PER-33	In an FHL tendon transfer, the FHL tendon (which is a smaller tendon) is being tasked to provide plantar flexion in place of a damaged or resected Achilles tendon. Consequently, positioning the attachment point for the transferred FHL can be important to get an optimal desired biomechanical pull on the calcaneus, to get the optimal lever arm for plantar flexion.	299	Added by DJM Jan 2024	1/6/24, 9:58 PM
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

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