Outcomes Following Targeted Muscle Reinnervation in Pediatric Amputations: A Systematic Review

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.