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Conditioning electrical stimulation (CES) before lower limb distal nerve transfer (DNT) significantly enhanced nerve regeneration and functional recovery for treating foot drop. This method improved walking speed and ankle dorsiflexion without damaging the donor nerve.

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Area of Science:

  • Neuroscience
  • Regenerative Medicine
  • Surgical Innovation

Background:

  • Lower limb distal nerve transfers (DNT) for conditions like foot drop have suboptimal outcomes due to lengthy regeneration distances.
  • Rerouting tibial nerve branches to the common fibular nerve aims to restore ankle dorsiflexion, but regeneration is a challenge.

Purpose of the Study:

  • To investigate if conditioning electrical stimulation (CES) applied to the tibial nerve prior to DNT surgery can accelerate nerve regeneration.
  • To determine if CES enhances functional recovery of ankle dorsiflexion and overall locomotion after DNT.

Main Methods:

  • Animals underwent common fibular nerve crush followed by tibial nerve CES in half the cohort.
  • Distal nerve transfer (DNT) was performed, and outcomes assessed via kinetic, kinematic, locomotion, electrophysiologic, and immunohistochemical analyses.
  • The study specifically examined CES effects on nerve regeneration and potential donor nerve injury.

Main Results:

  • CES significantly accelerated nerve regeneration (p < 0.001) and improved walking speed and skilled locomotion.
  • Restored ankle dorsiflexion, increased vertical peak forces, and improved propulsive forces were observed (p < 0.01).
  • Muscle reinnervation was confirmed; CES did not induce donor nerve degeneration or macrophage infiltration.

Conclusions:

  • Preoperative tibial nerve CES significantly enhances functional recovery following lower limb DNT for foot drop.
  • CES promotes nerve regeneration and sensorimotor recovery without adverse effects on the donor nerve.
  • This strategy offers a promising approach to improve outcomes for DNT procedures.