This first-in-human pilot study tests whether the regenerative peripheral nerve interface (RPNI) can provide stable, high-fidelity motor control signals for real-time prosthetic hand control. Four upper limb amputees across varying amputation levels (wrist disarticulation to glenohumeral) received RPNIs created by implanting transected peripheral nerve fascicles into free vastus lateralis muscle grafts. The study evaluates ultrasound-confirmed reinnervation, EMG signal quality, and prosthetic control accuracy over up to 300 days.
Upper limb amputees with high-level amputations have no residual hand or forearm musculature to drive conventional myoelectric prostheses. Nerve cuff and intraneural electrode approaches exist but are limited by low SNR (4–15) and long-term signal degradation — the paper's introduction frames this as the core unmet need.
When a patient with a transhumeral or glenohumeral amputation presents wanting dexterous prosthetic control, RPNI should be part of your reconstruction plan. The technique can be performed at the time of amputation for neuroma prevention or as a staged procedure for neuroma treatment. And the same construct then serves as the prosthetic interface.
The dual-purpose nature of RPNI changes how you counsel patients: the reconstructive conversation (neuroma pain) and the rehabilitation conversation (prosthetic control) are the same operation. A patient who comes to you with postamputation neuroma pain is also a candidate for improved prosthetic function.
The ~3-month graft maturation window is a practical planning point. Prosthetic programming and electrode implantation should not begin until at least 3 months after RPNI surgery, and the clinical data here show sessions beginning 4–11 months postoperatively.
This first-in-human pilot study tests whether the regenerative peripheral nerve interface (RPNI) can provide stable, high-fidelity motor control signals for real-time prosthetic hand control. Four upper limb amputees across varying amputation levels (wrist disarticulation to glenohumeral) received RPNIs created by implanting transected peripheral nerve fascicles into free vastus lateralis muscle grafts. The study evaluates ultrasound-confirmed reinnervation, EMG signal quality, and prosthetic control accuracy over up to 300 days.
Upper limb amputees with high-level amputations have no residual hand or forearm musculature to drive conventional myoelectric prostheses. Nerve cuff and intraneural electrode approaches exist but are limited by low SNR (4–15) and long-term signal degradation — the paper's introduction frames this as the core unmet need.
When a patient with a transhumeral or glenohumeral amputation presents wanting dexterous prosthetic control, RPNI should be part of your reconstruction plan. The technique can be performed at the time of amputation for neuroma prevention or as a staged procedure for neuroma treatment. And the same construct then serves as the prosthetic interface.
The dual-purpose nature of RPNI changes how you counsel patients: the reconstructive conversation (neuroma pain) and the rehabilitation conversation (prosthetic control) are the same operation. A patient who comes to you with postamputation neuroma pain is also a candidate for improved prosthetic function.
The ~3-month graft maturation window is a practical planning point. Prosthetic programming and electrode implantation should not begin until at least 3 months after RPNI surgery, and the clinical data here show sessions beginning 4–11 months postoperatively.