Effectiveness of pre-emptive targeted muscle reinnervation on post-amputation pain in patients undergoing above knee amputation: A randomized controlled trial

BACKGROUND: Postamputation pain in amputees is a major cause of morbidity. Studies have highlighted the impact of preemptive surgical intervention of the amputated nerves for treatment of postamputation pain. The study aimed to analyze the role of targeted muscle reinnervation (TMR) at the time of limb loss in addressing both residual limb pain and phantom limb pain. METHODS: A randomized controlled trial (RCT) in acutely injured patients undergoing above-knee amputation (AKA) (n = 97) were randomized into two groups with equal allocation, i.e., group A with TMR (intervention) and group B with conventional stump formation (control) at the time of amputation using mixed block randomization. The timeframe for the outcome analysis was 48 hours and 12 weeks postamputation. The psychological well-being was assessed using the Hospital Anxiety and Depression Scale (HADS), McGill Pain Questionnaire (MPQ), and functionality using Patient Reported Outcomes Measurement Information System (PROMIS) pain questionnaires. The anatomical evaluation of the severed nerve was done at 12 weeks with high-frequency ultrasonography. RESULTS: The majority of the patients were males (n = 92, 94.8%) with a mean age of 32.5 years. The mean Mangled Extremity Severity Score (MESS) was comparable ( p = 0.98) between the groups. The difference of the mean NRS of the residual limb pain (1.8 vs. 3.3) and phantom limb pain (1.2 vs. 2.6) was statistically significant between the two groups ( p = 0.001). The psychological scores HADS, MPQ, and PROMIS were statistically significant. The neuroma size measured using ultrasound at 12 weeks was statistically significant between the groups ( p < 0.05). CONCLUSION: The preemptive surgical intervention of amputated nerve at the time of amputation by TMR techniques significantly reduces the postoperative residual limb pain and phantom limb pain at 3 months follow up.( J Trauma Acute Care Surg . 2026;100: 871-878. © 2026 American Association for the Surgery of Trauma.). LEVEL OF EVIDENCE: Randomized Controlled Trial with no negative criteria; Level I.