First metatarsal lateral release instrument and technique
Instruments and techniques can be used to release a first metatarsal for realignment. In some implementations, a techniques involves surgically accessing a sesamoidal ligament in a foot of a patient and advancing a guiding projection of a cutting instrument under the sesamoidal ligament. This can capture the sesamoidal ligament between the guiding projection of the cutting instrument and a cutting surface of the cutting instrument that is recessed relative to a distal end of the guiding projection. The techniques further involves cutting the sesamoidal ligament with the cutting surface of the cutting instrument.
1 . A method of releasing a first metatarsal for realignment, the method comprising:
surgically accessing a sesamoidal ligament in a foot of a patient;
advancing a guiding projection of a cutting instrument under the sesamoidal ligament, thereby capturing the sesamoidal ligament between the guiding projection of the cutting instrument and a cutting surface of the cutting instrument recessed relative to a distal end of the guiding projection; and
subsequently cutting the sesamoidal ligament with the cutting surface of the cutting instrument.
2 . The method of claim 1 , wherein advancing the guiding projection of the cutting instrument under the sesamoidal ligament comprises advancing the cutting instrument in distal to proximal direction in an intermetatarsal space separating a first metatarsal from a second metatarsal.
3 . The method of claim 1 , wherein advancing the guiding projection of the cutting instrument under the sesamoidal ligament comprises pushing the cutting instrument in a first direction, and subsequently cutting the sesamoidal ligament with the cutting surface comprises further pushing the cutting instrument in the first direction.
4 . The method of claim 1 , wherein:
advancing the guiding projection of the cutting instrument under the sesamoidal ligament comprises advancing the guiding projection of the cutting instrument under an accessory supervisory ligament; and
subsequently cutting the sesamoidal ligament with the cutting surface of the cutting instrument comprises cutting the accessory supervisory ligament.
5 . The method of claim 4 , further comprising advancing the guiding projection of the cutting instrument under a proper collateral ligament, and subsequently cutting the proper collateral ligament.
6 . The method of claim 4 , further comprising:
advancing the guiding projection of the cutting instrument under at least one of a lateral sesamoid phalangeal ligament, a lateral metatarsophalangeal ligament, an adductor tendon, and a deep transverse metatarsal ligament; and
cutting the at least one of the lateral sesamoid phalangeal ligament, the lateral metatarsophalangeal ligament, the adductor tendon, and the deep transverse metatarsal ligament with the cutting surface of the cutting instrument.
7 . The method of claim 1 , wherein advancing the guiding projection of the cutting instrument under the sesamoidal ligament comprises advancing the guiding projection of the cutting instrument between the sesamoidal ligament and a surface of at least one of a first metatarsal and a proximal phalanx.
8 . The method of claim 1 , wherein surgically accessing the sesamoidal ligament comprises cutting into a first metatarsophalangeal joint capsule.
9 . The method of claim 8 , wherein cutting into the first metatarsophalangeal joint capsule comprises cutting into a lateral side of the first metatarsophalangeal joint capsule from a dorsal side of the foot.
10 . The method of claim 1 , wherein the cutting surface defines a cutting edge, and a distal-most edge of the cutting surface is spaced a distance from the distal end of the guiding projection a distance within a range from 5 mm to 15 mm.
11 . The method of claim 1 , wherein:
the cutting instrument comprises a cutting head defining the cutting surface and the guiding projection;
the cutting head defines a length extending from the distal end to a proximal end, and a width perpendicular to the length, the width extending from a first side edge of the cutting head to a second side edge of the cutting head; and
the guiding projection forms the second side edge of the cutting head.
12 . The method of claim 11 , wherein:
the guiding projection comprises a first guiding projection and a second guiding projection;
the first guiding projection forms the first side edge of the cutting head; and
the second guiding projection forms the second side edge of the cutting head.
13 . The method of claim 1 , wherein the guiding projection defines a cylindrical cross-sectional shape along at least a portion of its length.
14 . The method of claim 1 , wherein the distal end of the guiding projection is blunt, and the guiding projection comprises a tapers down to the blunt distal end.
15 . The method of claim 1 , wherein the cutting instrument comprises a cutting head defining the cutting surface and the guiding projection, the cutting head defines a thickness, and the thickness of the cutting head tapers across the cutting surface.
16 . The method of claim 15 , wherein the thickness of the cutting head tapers across the cutting surface at a taper angle within a range from 5 degrees to 25 degrees.
17 . A method of realigning at least a portion of a first metatarsal, the method comprising:
surgically accessing a sesamoidal ligament in a foot of a patient;
advancing a guiding projection of a cutting instrument under the sesamoidal ligament, thereby capturing the sesamoidal ligament between the guiding projection of the cutting instrument and a cutting surface of the cutting instrument recessed relative to a distal end of the guide projection, and subsequently cutting the sesamoidal ligament with the cutting surface of the cutting instrument;
moving at least a portion of a first metatarsal in at least one plane; and
fixating a moved position of the portion of the first metatarsal by applying at least one bone fixation device.
18 . The method of claim 17 , wherein moving at least the portion of the first metatarsal in at least one plane comprises moving an entire length of the first metatarsal in at least one plane, and further comprising:
surgically accessing a tarsometatarsal joint separating the first metatarsal from a medial cuneiform in the foot of the patient;
preparing an end of the first metatarsal; and
preparing an end of the medial cuneiform.
19 . The method of claim 17 , further comprising cutting the first metatarsal into a distal portion and a proximal portion, wherein moving at least the portion of the first metatarsal in at least one plane comprises moving the distal portion of the first metatarsal relative to the proximal portion.
20 . The method of claim 17 , wherein the at least one plane comprises a frontal plane.
21 . The method of claim 17 , wherein advancing the guiding projection of the cutting instrument under the sesamoidal ligament comprises advancing the guiding projection of the cutting instrument under an accessory supervisory ligament; and
subsequently cutting the sesamoidal ligament with the cutting surface of the cutting instrument comprises cutting the accessory supervisory ligament.
22 . The method of claim 21 , further comprising advancing the guiding projection of the cutting instrument under a proper collateral ligament, and subsequently cutting the proper collateral ligament.
23 . The method of claim 21 , further comprising:
advancing the guiding projection of the cutting instrument under at least one of a lateral sesamoid phalangeal ligament, a lateral metatarsophalangeal ligament, an adductor tendon, and a deep transverse metatarsal ligament; and
cutting the at least one of the lateral sesamoid phalangeal ligament, the lateral metatarsophalangeal ligament, the adductor tendon, and the deep transverse metatarsal ligament with the cutting surface of the cutting instrument.
24 . The method of claim 17 , wherein surgically accessing the sesamoidal ligament comprises cutting into a lateral side of a first metatarsophalangeal joint capsule.