Meralgia paresthetica (MP) is a disabling clinical condition manifested by a set of neuropathic symptoms (allodynia, dysesthesia, hyperalgesia, hypoesthesia, pain) related to compression or injury along the path of the lateral femoral cutaneous nerve (LFCN) (Scholz et al., 2023).

The LFCN originates from the posterior division of the anterior rami of the L2 L3 lumbar spinal nerves in most cases but can rarely (0,8 % of cases for Benes et al.) derivate from the genito-femoral nerve or the femoral nerve (Benes et al., 2024). It crosses the pelvis, mostly resting on the iliac muscle, and exits near the anterior superior iliac spine (ASIS) where it exhibits its major anatomical variability: in more than 85 % of cases, it passes medial to the ASIS and under the inguinal ligament. More rarely it may pass on or in a bifurcation of the inguinal ligament (7.5 %), lateral to the ASIS (5 %), or even in a bony canal in the ASIS (2.5 %). It then generally divides into two terminal branches innervating the anterolateral aspect of the thigh. (Tomaszewski et al., 2016).

With an incidence of 4.3 cases per 100,000 (van Slobbe et al., 2004), meralgia paresthetica main etiology is idiopathic and related to the compression of the LFCN as it passes under the inguinal ligament. Predisposing anatomical variations are also well known (Johnson et al., 2025):•

passage under the inguinal ligament less than 1 cm from the anterior superior iliac spine or lateral passage from the anterior superior iliac spine (ASIS)

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superficial passage relative to the inguinal ligament.

It can also be iatrogenic in origin and, with a rate of 31 % (Dahm et al., 2021) of symptomatic postoperative lesions, anterior total hip arthroplasty surgery, the incidence of which is increasing, has become the main cause (Xu et al., 2022).

The treatment of meralgia paresthetica is challenging, as corticosteroid injections and neurolysis provide complete pain relief in only 22 % and 63 % of cases, respectively (Lu et al., 2021). Neurectomy provides relief for 85 % of patients (Lu et al., 2021) at the cost of other neuropathic pain related to resection of the neuroma (De Ruiter et al., 2021). Neurectomy associated with nerve end implantation has been scarcely studied (Finerty et al., 2025) apparently with good results but also at the risk of neuropathic pain related to neurectomy.

In the context of neuropathic pain management surgery, targeted muscle reinnervation (TMR) is a recent technique that allows the axons of a damaged sensory nerve to regrow into the motor end plates of a muscle, thereby preventing the formation of a neuroma (Lanier et al., 2020). This involves creating a direct connection between a damaged sensory nerve and a motor nerve linked to its muscle effector (see Fig. 1).

Targeted muscle reinnervation has proven to be superior to "standard techniques" in the management of post-amputation neuropathic pain, with 67 % vs. 27 % of patients experiencing no or little neuropathic pain (Dumanian et al., 2019). The indications for targeted muscle reinnervation have naturally been extended to neuromas of the radial (Grome et al., 2020), saphenous (Janes et al., 2020), sural (Fracol et al., 2020), and ilioinguinal (Chappell et al., 2021) nerves, also with encouraging results.

To our knowledge, no work has been done on the use of this technique in the management of meralgia paresthetica, which would have the advantage, among others, over neurectomy of not leaving a post-surgical resection neuroma (Zimmermann, 2001).

The terminal branch of the superior gluteal nerve (SGN) for the tensor fasciae latae muscle seems a suitable candidate as a recipient for targeted muscle reinnervation of the LFCN:•

It is the only muscular nerve branch with a transverse trajectory in the vicinity of the LFCN's passage under the inguinal ligament, which will allow it to elongate relatively when transposed above the inguinal ligament (see Fig. 2) (Takada et al., 2018).

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Its entry point into the TFL muscle has a predictable and tight distribution in the proximal second quarter of the muscle body (Choi et al., 2023, Grob et al., 2015).

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The TFL muscle has redundant innervation in 70.8 % of cases (Tempski et al., 2025), which limits the risk of complete denervation of the muscle during harvesting. In cases of innervation by a single branch, paralysis of the TFL muscle has little clinical impact (Hoch et al., 2025).

The aim of this study was to describe the feasibility of a targeted muscle reinnervation technique for the treatment of meralgia paresthetica by direct coaptation of the lateral femoral cutaneous nerve to the motor branch of the tensor fasciae latae muscle.

The specifications were as follows:•

The need to perform the coaptation at least 1 cm above the inguinal ligament (the usual site of compression)

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The need to adapt to anatomical variations of the LCFN

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A single technique suitable for both idiopathic and iatrogenic cases

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The need for a single approach