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Updated: Jun 23, 2026
Targeted Muscle Reinnervation: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain
Published on: March 8, 2024
Outcomes Following Targeted Muscle Reinnervation in Pediatric Amputations: A Systematic Review
Martin J Giuffre1,2, Alexander Platt1,2, Cynthia K Kahl1,2
1From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Targeted muscle reinnervation (TMR) in pediatric amputees effectively resolves neuroma and phantom limb pain (PLP), improving prosthetic use and reducing narcotic dependence. Further research with standardized measures is recommended.
Area of Science:
- Surgical Innovation
- Pediatric Orthopedics
- Pain Management
Background:
- Targeted muscle reinnervation (TMR) is established for adults with amputation to reduce neuroma and phantom limb pain (PLP).
- The efficacy of TMR in pediatric amputees is not well-defined.
- This systematic review examines TMR outcomes in children and adolescents.
Purpose of the Study:
- To evaluate the effectiveness of TMR in pediatric amputees.
- To assess pain reduction, prosthetic utilization, and complication rates following TMR in young patients.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Searched databases included PubMed, MEDLINE, Embase, and Google Scholar for studies on TMR in patients under 18.
- Outcomes assessed included neuroma/pain resolution, pain scores (NRS), PROMIS scores, prosthetic use, narcotic use, and complications.
Main Results:
- Six retrospective studies involving 16 pediatric amputees were analyzed.
- 100% resolution of neuroma and overall pain was observed.
- Mean NRS scores for residual limb pain and PLP were 2.0 and 3.7, respectively.
- PROMIS scores indicated outcomes comparable to adult TMR studies.
- Nine of 12 patients achieved prosthetic use, and 10 of 11 narcotic users discontinued use.
- Complications occurred in 12.5% of patients and were resolved after revision.
Conclusions:
- TMR appears to be a beneficial intervention for pediatric amputees.
- It may effectively reduce neuropathic pain, facilitate prosthetic adoption, and decrease medication reliance.
- Further prospective studies employing standardized outcome measures are necessary to confirm these findings.
Background:
Targeted muscle reinnervation (TMR) coapts transected peripheral nerves to nearby motor nerves in residual muscles, reducing neuroma formation and phantom limb pain (PLP). Although benefits are established in adults, its role in pediatric patients remains unclear. This systematic review evaluates outcomes of TMR in pediatric amputees.
Methods:
Following PRISMA guidelines, PubMed, MEDLINE, Embase, and Google Scholar were searched for studies of immediate or delayed TMR in amputees younger than 18 years. Outcomes included neuroma and pain resolution, numerical rating scale (NRS), patient-reported outcomes measurement information system scores, prosthetic use, narcotic use, and complications. Quality was assessed using Joanna Briggs Institute tools.
Results:
Six retrospective studies (16 patients) met inclusion criteria. Primary TMR was performed in 14 patients, and delayed TMR in 2. Neuroma and overall pain resolution were observed in 100% of patients. Mean NRS scores (0, no pain; 10, worst pain) for residual limb pain and PLP were 2.0 ± 1.8 and 3.7 ± 2.1. Patient-reported outcomes measurement information system mean scores scores corresponded with equivalent outcomes in adult studies (residual limb pain: 38.6, 42.7, 42.0; PLP: 44.0, 45.6, 44.6). Nine of 12 patients proceeded with prosthetic use (8 lower extremity; 1 upper extremity), indicating early adoption and function. Of 11 patients using narcotics, 10 discontinued by the final follow-up. Complications occurred in 12.5% (2 of 16) of patients and resolved after revision.
Conclusions:
TMR in pediatric amputations may reduce neuropathic pain, support prosthetic use, and decrease reliance on pain medication. Prospective studies with standardized measures are warranted.
