Regenerative peripheral nerve interfaces (RPNIs): an overview of innovative surgical approaches

Complications following amputation can be devastating for patients, including debilitating neuropathic pain, the inability to perform activities of daily living (ADLs) or gain meaningful employment. While prosthesis use allows patients to restore independence and reintegrate into daily activities, patients often abandon these devices. Despite the immense advancements in prosthetic technology, there is still a need for an interface that can provide a natural experience with accurate and reliable long-term control. The Regenerative Peripheral Nerve Interface (RPNI) is a simple surgical technique that offers real-time control of myoelectric prosthetic devices to restore extremity function. This stable, biological nerve interface successfully amplifies efferent motor action potentials, provides sensory feedback, and offers a more functional prosthetic device experience. Based on the principles of RPNI, novel surgical approaches have been developed to expand its applications and improve outcomes. This review article summarizes the utilization of the RPNI and its recent modifications of different neural interfaces in the setting of major limb amputation and musculoskeletal injuries.