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Cited by 107Neuroscience and Neural EngineeringMuscle activation and electromyography studiesVagus Nerve Stimulation Research

The DOI matches its Crossref record; 32 of the 32 references it cites were found in a registry or an index; none of the 32 sources its claims cite is checked for support yet.

Fascicular anatomy of human femoral nerve: Implications for neural prostheses using nerve cuff electrodes

Open access
Gustafson, Kenneth J., Pinault, Gilles C. J., Neville, Jennifer J., Syed, Ishaq, Jr, John A. Davis, Jean-Claude, Jesse, Triolo, Ronald J.·2009·The Journal of Rehabilitation Research and Development
DOI 10.1682/jrrd.2008.08.0097PMC PMC2967182
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Abstract

Clinical interventions to restore standing or stepping by using nerve cuff stimulation require a detailed knowledge of femoral nerve neuroanatomy. We harvested eight femoral nerves with all distal branches and characterized the branching patterns and diameters. The fascicular representation of each distal nerve was identified and traced proximally to create fascicle maps of the compound femoral nerve in four cadaver specimens. Distal nerves were consistently represented as individual fascicles or distinct groups of fascicles in the compound femoral nerve. Branch-free length of the compound femoral nerve was 1.50 +/- 0.47 cm (mean +/- standard deviation). Compound femoral nerve cross sections were noncircular with major and minor diameters of 10.50 +/- 1.52 mm and 2.30 +/- 0.63 mm, respectively. In vivo intraoperative measurements in six subjects were consistent with cadaver results. Selective stimulation of individual muscles innervated by the femoral nerve may therefore be possible with a single neural prosthesis able to selectively stimulate individual groups of fascicles.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Distal branches of the human femoral nerve are consistently represented as individual fascicles or distinct fascicle groups in the compound femoral nerve, with standing-relevant vasti fascicles centrally and usually dorsally located. These anatomy and morphology data support the feasibility of selective stimulation with a single multicontact nerve cuff electrode.

Key findings

  • Distal nerves were consistently represented as individual fascicles or distinct groups of fascicles in the compound femoral nerve; vastus medialis, vastus intermedius, and vastus lateralis fascicles were centrally and usually dorsally located, while sensory and rectus femoris fascicles were peripheral. No interfascicular plexus formations were observed.
  • Compound femoral nerve branch-free length was 1.50 ± 0.47 cm; cross sections were noncircular with major and minor diameters of 10.50 ± 1.52 mm and 2.30 ± 0.63 mm, respectively.
  • The compound femoral nerve just proximal to branching contained 33 ± 14 fascicles, and there was no statistically significant difference between the number of fascicles in the femoral nerve and the sum of fascicles in the distal branches.
  • In vivo intraoperative measurements in six subjects were consistent with cadaver results; in vivo heights were lower than cadaver values (p < 0.005) and width/height ratios were greater (p < 0.01), while widths, circumferences, and effective diameters were lower but not significantly (p > 0.05).

Methods

  • Harvested and dissected eight femoral nerves with all distal branches from four female formalin-fixed cadavers aged 87–99 years (mean = 91); measured branching patterns, branch-free lengths, circumferences, and major/minor axes.
  • Sectioned four cadaver femoral nerves at 5 mm intervals, stained with hematoxylin and eosin, and traced fascicles proximally to create fascicle maps from distal branches to the inguinal ligament.
  • Obtained in vivo intraoperative measurements of the compound femoral nerve just distal to the inguinal ligament in six male subjects (mean ± SD 62.20 ± 5.56 years, range 51–66) undergoing elective vascular surgery; analyzed data as mean ± SD using two-tailed Student t-test with significance at 0.05.

Limitations

  • The paper states that a relatively small number of cadavers was examined, that in vivo nerve height could not be verified with a ruler or surgical pictures and may have been underestimated, and that formalin fixation and histological processing may have altered cross-sectional dimensions.
  • The paper also notes that in vivo subjects had peripheral vascular disease and were male, whereas cadaveric specimens were female, and that tissue processing effects were contrary to expectations.
  • Evident from the text: the cadaver sample was elderly female (87–99 years) and the in vivo sample was male patients undergoing vascular surgery, limiting generalizability; fascicle maps were validated only in cadavers, with in vivo work limited to cross-sectional dimensions.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1682/jrrd.2008.08.0097

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 32 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Branch-free length of the compound femoral nerve was 1.50 ± 0.47 cm (mean ± standard deviation).

    “Branch-free length of the compound femoral nerve was 1.50 +/− 0.47 cm (mean +/− standard deviation).”
    • Also stated in: § Anatomy and Morphology · plain
      “The distance from the inguinal ligament to the first branching point of the femoral nerve was 1.50 ± 0.47 cm (range 1–2).”
    Quote in the paperSubstantial claim
  • Findingown data

    Distal nerves were consistently represented as individual fascicles or distinct groups of fascicles in the compound femoral nerve.

    “Distal nerves were consistently represented as individual fascicles or distinct groups of fascicles in the compound femoral nerve.”
    • Also stated in: § Fascicular Anatomy · plain
      “Distinct fascicles or groups of fascicles in each compound femoral nerve represented distal nerve branches of the femoral nerve (sartorius, pectineus, medial cutaneous, saphenous, vastus medialis, vastus intermedius, vastus lateralis, and rectus femoris).”
    Quote in the paperSubstantial claim
  • Findingown data

    Compound femoral nerve cross sections were noncircular with major and minor diameters of 10.50 ± 1.52 mm and 2.30 ± 0.63 mm, respectively.

    “Compound femoral nerve cross sections were noncircular with major and minor diameters of 10.50 +/− 1.52 mm and 2.30 +/− 0.63 mm, respectively.”
    Quote in the paperSubstantial claim
  • Findingown data

    The femoral nerve cross sections were elongated ellipses rather than circles.

    “The femoral nerve cross sections were elongated ellipses rather than circles.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In vivo heights of the compound femoral nerve were less than those measured in cadavers (p < 0.005).

    “We found the in vivo heights to be less than those we measured in the cadavers (p < 0.005), resulting in a greater width/height ratio (p < 0.01) than those we observed in the postmortem tissue (Table 3).”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one. 34
  • Probably not a substantial claim. 13

  • It may state two separate claims as one.

    Findingown data

    There was no statistical difference in femoral nerve cross-sectional measurements between the left and right sides or between measurements taken pre- and posttissue processing.

    “We found no statistical difference in these measurements between the left and right sides or between measurements taken pre- and posttissue processing.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    In vivo widths, circumferences, and effective diameters of the compound femoral nerve were lower than postmortem values but not significantly (p > 0.05).

    “Although the in vivo widths, circumferences, and effective diameters were lower than the postmortem values, these were not significant (p > 0.05).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    The vastus medialis, vastus intermedius, and vastus lateralis muscles were centrally located and the rectus femoris muscle was lateral in the branching pattern of all specimens.

    “The vastus medialis, vastus intermedius, and vastus lateralis muscles were centrally located and the rectus femoris muscle was lateral in the branching pattern of all specimens.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Fascicles from the sartorius nerve usually left ventrally, but were located in either the lateral, medial, or central portion of the femoral nerve.

    “Although we found fascicles from the sartorius nerve usually left ventrally, they were located in either the lateral, medial, or central portion of the femoral nerve.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Although fascicular anatomy varied between nerves, the fascicular pattern of the primary targets for standing function (vasti nerves) remained consistent between specimens.

    “Although the fascicular anatomy varied between nerves, the fascicular pattern of the primary targets for standing function (vasti nerves) remained consistent between specimens.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    The sartorius muscle branched laterally in one specimen.

    “The sartorius muscle branched laterally in one specimen.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    All femoral nerves had average branch-free lengths >1.0 cm and effective diameters >5.9 mm.

    “All femoral nerves had average branch-free lengths >1.0 cm and effective diameters >5.9 mm.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    The major branches involved in standing (vastus medialis, vastus intermedius, and vastus lateralis nerves) were always centrally located, while the sensory branches and the branches not implicated in standing (saphenous, medial cutaneous, sartorius, and rectus femoris nerves) were always located in the medial or lateral part of the branching pattern.

    “We always found the major branches involved in standing (vastus medialis, vastus intermedius, and vastus lateralis nerves) centrally located, while we always found the sensory branches and the branches not implicated in standing (saphenous, medial cutaneous, sartorius, and rectus femoris nerves) located in the medial or lateral part of the branching pattern.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Our data concur with Aizawa that the nerve branch to the pectineus nerve was the most medial branch of the femoral nerve in the thigh, except in one specimen where it was the second most medial branch after the sartorius nerve.

    “Our data concur with this; when the branch to the pectineus nerve was present, it was the most medial branch off the femoral nerve in all but one specimen, where it was the second most medial branch to leave the compound femoral nerve after the sartorius nerve.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Aizawa Y On the organization of the Plexus lumbalis. I. On the recognition of the three-layered divisions and the systematic description of the branches of the human femoral nerve Okajimas Folia Anat Jpn 1992 69 1 35 74 [PMID: 1620529] 1620529

  • It may state two separate claims as one.

    Findingown data

    We did not identify the pectineus nerves in three specimens or the medial cutaneous nerves in two specimens.

    “In addition, we did not identify the pectineus nerves in three specimens or the medial cutaneous nerves in two specimens.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    In our specimens, the branch to the medial cutaneous nerve was never more proximal than the second branch, and usually occurred after the branches to the pectineus and sartorius nerves.

    “However, in our specimens the branch to the medial cutaneous nerve was never more proximal than the second branch, and usually occurred after the branches to the pectineus and sartorius nerves.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Although the number of fascicles decreased proximally, there was no statistical difference between the number of fascicles in the femoral nerve and the sum of the number of branches in the distal branches.

    “Although the number of fascicles decreased proximally, we found no statistical difference between the number of fascicles in the femoral nerve and the sum of the number of branches in the distal branches.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    While the branch to the pectineus nerve was generally located on the superficial or anterior portion of the nerve, the branch to the sartorius nerve was always more superficial than the branch to the pectineus nerve.

    “While we found the branch to the pectineus nerve to generally be located on the superficial or anterior portion of the nerve, the branch to the sartorius nerve was always more superficial than the branch to the pectineus nerve.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Fascicles of branches leading to muscles implicated in standing (vastus medialis, vastus intermedius, vastus lateralis) are located centrally and usually dorsally on the femoral nerve.

    “Always centrally and usually dorsally, we found the fascicles of the branches leading to muscles implicated in standing (vastus medialis, vastus intermedius, vastus lateralis) located on the femoral nerve (Figure 2)”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    The fascicular pattern remained consistent throughout the longest section of the femoral nerve examined, and therefore the longest section of the femoral nerve with a constant pattern is a minimum of 15 mm.

    “We found that the fascicular pattern remained consistent throughout the longest section of the femoral nerve that we examined (Figure 3); therefore, the longest section of the femoral nerve with a constant pattern is a minimum of 15 mm.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    The compound femoral nerve has relatively flat cross-section dimensions, almost 4.8:1.0 width-to-height ratio in female cadavers and 7.5:1.0 in in vivo male subjects, which have not been previously reported.

    “The relatively flat cross-section dimensions (almost 4.8:1.0 width-to-height ratio in female cadavers [Table 3]; and 7.5:1.0 in in vivo male subjects [Table 4]) of the compound femoral nerve have not been previously reported.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    The nerve diameters and branch-free lengths for the compound femoral nerve and branches are mostly >2.0 mm in diameter and >1.5 cm in branch-free length.

    “The nerve diameters and branch-free lengths for the compound femoral nerve and branches (Table 2) are mostly >2.0 mm in diameter and >1.5 cm in branch-free length”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    A reduction in the number of fascicles was observed between the terminal branches of the femoral nerve and the femoral nerve in the thigh, but the difference was not statistically significant.

    “Although we observed a reduction in the number of fascicles between the terminal branches of the femoral nerve and the femoral nerve in the thigh (Table 5), we did not find this difference statistically significant.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Although the in vivo dimensions were not statistically lower than the postmortem values, their relative magnitude was contrary to expectations.

    “Although we did not find the in vivo dimensions to be statistically lower than the postmortem values, their relative magnitude was contrary to expectations.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    The width/height ratios observed in in vivo male subjects were similar to those observed in female cadavers, so the relatively flat geometry is consistent.

    “However, the width/height ratios we observed in in vivo male subjects were similar to those we observed in female cadavers. Therefore, the relatively flat geometry is consistent.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Study design and conductown data

    Successful fascicular tracing was performed in all specimens, and a tracing resolution of 5 mm was adequate in almost all sections.

    “We performed successful fascicular tracing in all specimens; we found a tracing resolution (distance between longitudinal sections) of 5 mm to be adequate in almost all sections.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The majority of the literature states that the adductor longus is innervated by the obturator nerve.

    “The majority of the literature states that the adductor longus is innervated by the obturator nerve [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Moore KL Dalley AF Clinically oriented anatomy 1999 Lippincott Williams & Wilkins Baltimore (MD) 4th ed.

  • It may state two separate claims as one.

    Interpretationreasoning

    Any point on the compound femoral nerve between the first branching point and the inguinal ligament allows access to fascicles from each distal nerve and is a potential site for nerve cuff electrode placement.

    “Any point on the compound femoral nerve between the first branching point and the inguinal ligament allows access to fascicles from each distal nerve and is a potential site for nerve cuff electrode placement.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationown data

    The anatomy and morphology observed remained consistent with the established literature, suggesting that the chosen specimens did not differ from the standard population and that the fascicular results may be considered representative of the general population.

    “The anatomy and morphology we observed remained consistent with the established literature, suggesting that our chosen specimens did not differ from the standard population and that we may consider the facscicular results representative of the general population.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [24] Aizawa Y On the organization of the Plexus lumbalis. I. On the recognition of the three-layered divisions and the systematic description of the branches of the human femoral nerve Okajimas Folia Anat Jpn 1992 69 1 35 74 [PMID: 1620529] 1620529
    • cites [1] Moore KL Dalley AF Clinically oriented anatomy 1999 Lippincott Williams & Wilkins Baltimore (MD) 4th ed.

  • It may state two separate claims as one.

    Interpretationreasoning

    If distinct fascicles or groups of fascicles represent the distal nerves of the compound femoral nerve, distal muscles may possibly be controlled at a proximal site using a single multicontact nerve cuff electrode.

    “Therefore, if distinct fascicles or groups of fascicles represent the distal nerves of the compound femoral nerve, we may possibly control distal muscles at a proximal site using a single multicontact nerve cuff electrode.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    The femoral nerve originates from the second, third, and fourth lumbar spinal nerves and innervates the anterior thigh muscles, hip and knee joints, and skin on the anteromedial thigh.

    “The femoral nerve originates from the second, third, and fourth lumbar spinal nerves and innervates the anterior thigh muscles, hip and knee joints, and skin on the anteromedial thigh [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Moore KL Dalley AF Clinically oriented anatomy 1999 Lippincott Williams & Wilkins Baltimore (MD) 4th ed.

  • Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationreasoning

    A single nerve cuff electrode able to selectively recruit multiple heads of the vasti muscles simultaneously would improve neuroprosthesis performance by extending standing time and eliminating the need for multiple implants.

    “A single nerve cuff electrode able to selectively recruit multiple heads of the vasti muscles simultaneously would improve neuroprosthesis performance by extending standing time and eliminating the need for multiple implants.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    For complete recruitment using muscle-based electrodes, multiple electrodes must be placed within the muscle belly, which is surgically time consuming and can be difficult to implement.

    “For complete recruitment using muscle-based electrodes, multiple electrodes must be placed within the muscle belly, which is surgically time consuming and can be difficult to implement [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Kagaya H Shimada Y Ebata K Sato M Sato K Yukawa T Obinata G Restoration and analysis of standing-up in complete paraplegia utilizing functional electrical stimulation Arch Phys Med Rehabil 1995 76 9 876 81 [PMID: 7668962] DOI:10.1016/S0003-9993(95)80556-7 7668962

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The average number of fascicles in the upper part of the femoral nerve has been reported to be 36 fascicles.

    “The average number of fascicles in “the upper part” of the femoral nerve has been reported to be 36 fascicles [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Urbanowicz Z Femoral nerve fascicles in the human post-fetal life Folia Morphol (Warsz) 1981 39 3 283 91 [PMID: 6973517] 6973517

  • Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.

    Interpretationreasoning

    Knowledge of femoral nerve anatomy is critical for defining surgical approaches to the nerve, identifying the most practical and desirable locations for nerve cuff electrodes, and developing implementation strategies for advanced implanted neural prostheses.

    “Furthermore, this knowledge is critical for defining surgical approaches to the nerve, identifying the most practical and desirable locations for nerve cuff electrodes, and developing implementation strategies for advanced implanted neural prostheses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Interpretationreasoning

    The fascicular structure of the compound femoral nerve and the relationship of individual fascicles to distal nerve branches and terminal muscles are required to determine the electrode specifications and initial feasibility of selectively activating individual fascicles within the compound nerve with a single proximally located nerve cuff electrode.

    “Finally, we require the fascicular structure of the compound femoral nerve and the relationship of individual fascicles to distal nerve branches and terminal muscles to determine the electrode specifications and initial feasibility of selectively activating individual fascicles within the compound nerve with a single proximally located nerve cuff electrode.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisecitation

    Some nerve portions may proceed for considerable distances with no major change in position or composition; functional units and often discrete branches may remain localized in the same quadrants of nerve trunks for considerable distances and therefore may be surgically isolated.

    “Some nerve portions may proceed for considerable distances with no major change in position or composition; functional units and often discrete branches may remain localized in the same quadrants of nerve trunks for considerable distances and therefore may be surgically isolated [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Jabaley ME Wallace WH Heckler FR Internal topography of major nerves of the forearm and hand: A current view J Hand Surg Am 1980 5 1 1 18 [PMID: 7365209] 7365209

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Interpretationnone given

    The consistent location of the compound femoral nerve at the midpoint between the ASIS and pubic symphysis allows for precise and repeatable surgical access based on readily defined surface anatomical landmarks.

    “The consistent location of the compound femoral nerve at the midpoint between the ASIS and pubic symphysis allows for precise and repeatable surgical access based on readily defined surface anatomical landmarks.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    Modeling simulations using the fascicular anatomy presented here suggest that a multicontact flat interfacing nerve cuff electrode can selectively activate each individual fascicular group without activating any other muscle above threshold.

    “Indeed, modeling simulations using the fascicular anatomy presented here suggest that a multicontact flat interfacing nerve cuff electrode can selectively activate each individual fascicular group (i.e., muscle group) without activating any other muscle above threshold [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Schiefer MA Triolo RJ Tyler DJ A model of selective activation of the femoral nerve with a flat interface nerve electrode for a lower extremity neuroprosthesis IEEE Trans Neural Syst Rehabil Eng 2008 16 2 195 204 [PMID: 18403289] DOI:10.1109/TNSRE.2008.918425 18403289 PMC2920206

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    The number of fascicles can vary between individuals and sides of the body, and fascicles are more numerous distal than proximal.

    “The number of fascicles can vary between individuals and sides of the body, and fascicles are more numerous distal than proximal [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Sunderland S The intraneural topography of the radial, median, and ulnar nerves Brain 1945 68 4 243 98 DOI:10.1093/brain/68.4.243 20982793

  • It may state two separate claims as one.

    Study design and conductown data

    The intercadaver variability was relatively low and did not affect the conclusions.

    “The intercadaver variability was relatively low and did not affect our conclusions.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Study design and conductown data

    Although a relatively small number of cadavers was examined, the anatomy and morphology data remain consistent with earlier reports and the fascicular data remain consistent between cadaver specimens and in vivo measurements.

    “Although we examined a relatively small number of cadavers, the anatomy and morphology data remain consistent with earlier reports and the fascicular data remain consistent between both cadaver specimens and in vivo measurements.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.

    Interpretationreasoning

    The potentially increased selectivity could improve performance of muscle-based electrode designs and provide more complete muscle recruitment.

    “The potentially increased selectivity could improve performance of muscle-based electrode designs and provide more complete muscle recruitment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationnone given

    It is possible that the in vivo data collected were artificially low because of the peripheral vascular disease that necessitated surgical exposure of the femoral artery to provide access to the femoral nerve.

    “Alternatively, it is possible that the in vivo data we collected were artificially low because of the peripheral vascular disease that necessitated surgical exposure of the femoral artery to provide access to the femoral nerve.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Interpretationreasoning

    The results of this study support further development and testing of nerve cuff electrode-based interventions to restore standing function to individuals paralyzed by SCI.

    “Therefore, the results of this study support further development and testing of nerve cuff electrode-based interventions to restore standing function to individuals paralyzed by SCI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.

    Interpretationown data

    These data allow for the evaluation of potential surgical access points, locations for nerve anastamoses or stimulating nerve cuff electrodes, and initial evaluation of the feasibility of accessing distal branches at the level of the compound femoral nerve.

    “These data allow for the evaluation of potential surgical access points, locations for nerve anastamoses or stimulating nerve cuff electrodes, and initial evaluation of the feasibility of accessing distal branches at the level of the compound femoral nerve.”
    Quote in the paperNot a substantial claim
41 of 41

  • The paper relies on this without support.

    The fascicular anatomy and specific dimensions of the human femoral nerve have not been fully described and must be quantitatively documented.

    “However, the fascicular anatomy and specific dimensions of the human femoral nerve have not been fully described and must be quantitatively documented.”

  • The paper relies on this without support.

    Muscles innervated by the femoral nerve are prime movers for leg extension at the knee joint and thigh flexion and critical for standing and stepping function.

    “Muscles innervated by the femoral nerve are prime movers for leg extension at the knee joint and thigh flexion and critical for standing and stepping function.”

  • The paper relies on this without support.

    The three vasti muscles are important for standing function; they extend the leg at the knee joint without flexing the thigh, which would be detrimental to a stable upright posture.

    “The three vasti muscles are important for standing function; they extend the leg at the knee joint without flexing the thigh, which would be detrimental to a stable upright posture.”

  • The paper relies on this without support.

    Vastus medialis is important for locking the knee in terminal extension and preventing patellar drift and lateral subluxation that could possibly be caused by the pull of the vastus lateralis.

    “The vastus medialis muscle is important for locking the knee in terminal extension and preventing the patellar drift and lateral subluxation that could possibly be caused by the pull of the vastus lateralis.”

  • The paper relies on this without support.

    The pectineus muscle generates low forces easily counteracted by other thigh muscles, and the saphenous and medial cutaneous sensory nerves are unessential to standing.

    “The pectineus muscle generates low forces easily counteracted by other thigh muscles, and the saphenous and medial cutaneous sensory nerves are unessential to standing.”

  • The paper relies on this without support.

    Nerve cuff electrodes can completely activate the motor neurons they encompass and produce contractions closer to the maximal capacity than muscle-based designs.

    “Nerve cuff electrodes can completely activate the motor neurons they encompass and produce contractions closer to the maximal capacity than muscle-based designs.”

  • The paper relies on this without support.

    Distal nerves may be represented as distinct fascicles or groups of fascicles in proximal compound peripheral nerves.

    “Distal nerves may be represented as distinct fascicles or groups of fascicles in proximal compound peripheral nerves.”

  • The authors state this as an assumption.

    A circular approximation can be assumed for all fascicles.

    “We assumed a circular approximation for all fascicles and calculated the effective diameter (Deff) of each fascicle as 2 × (Area/π)0.5.”

  • The paper relies on this without support.

    Vastus lateralis and vastus intermedius are the strongest of the three vasti muscles.

    “Vastus lateralis and vastus intermedius are the strongest of the three muscles; therefore, they are commonly targeted by neural prostheses that employ functional electrical stimulation (FES) for standing after SCI [2-4].”

  • The paper relies on this without support.

    Epimysial and intramuscular electrodes rarely recruit all the motor units in a paralyzed muscle, especially in large lower-limb muscles with complex innervation patterns, leading to limited standing durations or insufficient stimulated joint moments to support taller and heavier implant recipients.

    “Epimysial and intramuscular electrodes rarely recruit all the motor units in a paralyzed muscle, especially in large lower-limb muscles with complex innervation patterns, leading to limited standing durations or insufficient stimulated joint moments to support taller and heavier implant recipients.”

  • The authors state this as an assumption.

    Peripheral nerves generally have a circular cross section.

    “Although we generally assumed peripheral nerves to have a circular cross section, they are commonly observed intraoperatively as flat, and relatively flat cross-sectional geometries have also been observed for the human pudendal and sciatic nerves (unpublished data from our laboratory) [27].”

  • The authors state this as an assumption.

    No studies of the fascicular anatomy of the femoral nerve exist.

    “While we are aware of no studies of the fascicular anatomy of the femoral nerve, Aizawa stated that the flow of nerve bundles of the femoral nerve (observed after removing the epineurium) was relatively smooth from the confluent part of the nerve to the branching part of the nerve [24].”

  • The authors state this as an assumption.

    The fascicles could be separated safely.

    “The consistency of the fascicular anatomy, the functional organization, and the lack of intrafascicular plexus formation all suggest that if the fascicles could be separated safely, intraneural dissection could be feasible.”
13 of 13

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Identification of fascicular contact points for electrode positioning is absolutely essential to selective interfacing with individual fascicles in a particular nerve.

    “According to Gustafson et al. (2009) and Badia et al. (2010), the identification of fascicular contact points for electrode positioning is absolutely essential to selective interfacing with individual fascicles in a particular nerve.”

    From Selectivity and Longevity of Peripheral-Nerve and Machine Interfaces: A Review. (2017) · cites this paper as Gustafson et al., 2009

    The Discussion (Clinical Implications; page not provided) says nerve cuff electrodes can selectively stimulate individual fascicles without prior knowledge of fascicular anatomy. That contradicts the claim that identifying fascicular contact points before electrode positioning is absolutely essential, although the paper does discuss how anatomy can inform electrode design. (LLM, conf=0.86)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Peripheral nerve size and composition varies greatly; the major and minor diameters of the compound femoral nerve are about 10.5 mm and 2.3 mm, respectively, while pelvic splanchnic nerve bundles can be smaller than 0.05 mm or larger than 0.2 mm.

    “for example, the major and minor diameters of the compound femoral nerve are about 10.5 mm and 2.3 mm, respectively. In contrast, the diameter of pelvic splanchnic nerve bundles can be smaller than 0.05 mm, or larger than 0.2 mm”

    From Realizing flexible bioelectronic medicines for accessing the peripheral nerves – technology considerations (2018) · cites this paper as Gustafson et al. 2009

  • Alternating stimulation of multiple agonist motor unit populations may reduce stimulation duty cycle and prolong the time of muscle contractions before the onset of fatigue.

    “Further, by alternating stimulation of multiple agonist motor unit populations, it may be possible to reduce stimulation duty cycle and prolong the time of muscle contractions before the onset of fatigue [6].”

    From Optimization of selective stimulation parameters for multi-contact electrodes (2013) · cites this paper as [6]

  • Motor units in their absolute refractory period, which lasts between 1.5 and 2.1 ms, will not respond to stimulation.

    “Another method for quantifying selectivity takes advantage of the concept that motor units in their absolute refractory period, which lasts between 1.5 and 2.1 ms, will not respond to stimulation [1,3,6,11-15].”

    From Optimization of selective stimulation parameters for multi-contact electrodes (2013) · cites this paper as [6]

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [22]Naples GG Mortimer JT Yuen TG Agnew WF McCreery DB Overview of peripheral nerve electrode design and implantation Neural prostheses: Fundamental studies 1990 107 44 Prentice Hall Englewood Cliffs (NJ)

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Metadata

Authors
Gustafson, K. J., Pinault, G. C. J., Neville, J. J., Syed, I., Jr, J. A. D., Jean-Claude, J., & Triolo, R. J.
Affiliations
  • Case Western Reserve University (US)
  • Louis Stokes Cleveland VA Medical Center (US)
Corresponding author
Gustafson, Kenneth J.
ORCID
Venue
The Journal of Rehabilitation Research and Development
Publisher
Journal of Rehabilitation Research & Development
Published
2009
Volume
46
Issue
7
Pages
973
ISSN
  • 0742-3241 (ISSN-L)
  • 0748-7711
DOI
10.1682/jrrd.2008.08.0097
PMC
PMC2967182
OpenAlex
W1994380628
Cited by
107
References
32
Citations by year
2026: 3 · 2025: 5 · 2024: 9 · 2023: 4 · 2022: 6 · 2021: 7 · 2020: 13 · 2019: 10 · 2018: 6 · 2017: 4 · 2016: 8 · 2015: 7 · 2014: 4 · 2013: 6 · 2012: 4
FWCI
1.66
Type
journal article
Language
en
Open access
Locations
  • The Journal of Rehabilitation Research and Development (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK077089)
  • National Institute of Neurological Disorders and Stroke (R01NS040547, NS40571)
  • National Institute of Biomedical Imaging and Bioengineering (EB-001889, R01EB001889)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD40298, K25HD040298)
Topics
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neural Engineering
  • Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
  • Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
Keywords
femoral nerve, cuff electrodes, neural prostheses, neurostimulation, nerve branching patterns, nerve diameter
MeSH terms
Aged, Aged, 80 and over, Cadaver, Electrodes, Implanted, Female, Femoral Nerve, Humans, Male, Middle Aged, Cohort Studies, Muscle, Skeletal

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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