133 Form

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Medical Policy Microprocessor-Controlled Prostheses for the Lower Limb
Table of Contents • Policy: Commercial • Description • Information Pertaining to All Policies
• Authorization Information • Policy History • References • Coding Information

Policy Number: 133

BCBSA Reference Number: 1.04.05 (For Plan internal use only) Related Policies
• Myoelectric Prosthetic Components for the Upper Limb, #227 • Neuromuscular Electrical Stimulation, #201 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity

A microprocessor-controlled knee may be considered MEDICALLY NECESSARY in amputees who meet the following requirements: • Demonstrated need for long distance ambulation at variable rates (use of the limb in the home or for basic community ambulation is not sufficient to justify provision of the computerized limb over standard limb applications) OR demonstrated patient need for regular ambulation on uneven terrain or for regular use on stairs (use of the limb for limited stair climbing in the home or employment environment is not sufficient evidence for prescription of this device over standard prosthetic application), AND
• Physical ability, including adequate cardiovascular and pulmonary reserve, for ambulation at faster than normal walking speed, AND • Adequate cognitive ability to master use and care requirements for the technology.

Amputees should be evaluated by an independent qualified professional to determine the most appropriate prosthetic components and control mechanism. A trial period may be indicated to evaluate the tolerability and efficacy of the prosthesis in a real-life setting. Decisions about the potential benefits of microprocessor-knees involve multiple factors including activity levels, as well as the individual’s physical and cognitive ability. An individual’s need for daily ambulation of at least 400 continuous yards, daily and frequent ambulation at variable cadence or on uneven terrain (eg, gravel, grass, curbs), and daily and frequent use of ramps and/or stairs (especially stair descent) should be considered as part of the decision. Typically, daily and frequent need of 2 or more of these activities would be needed to show benefit.

For individuals in whom the potential benefits of the microprocessor knees are uncertain, individuals may first be fitted with a standard prosthesis to determine their level of function with the standard device.

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The following are guidelines from the Veterans Health Administration Prosthetic Clinical Management Program Clinical Practice Recommendations for Microprocessor Knees (Berry 2000).

INDIVIDUAL SELECTION AND IDENTIFICATION A. Contraindications for use of the microprocessor knee should include: • Any condition that prevents socket fitting, such as a complicated wound or intractable pain which precludes socket wear. • Inability to tolerate the weight of the prosthesis. • Medicare Level K 0—no ability or potential to ambulate or transfer. • Medicare Level K 1—limited ability to transfer or ambulate on level ground at fixed cadence. • Medicare Level K 2—limited community ambulator that does not have the cardiovascular reserve, strength, and balance to improve stability in stance to permit increased independence, less risk of falls, and potential to advance to a less-restrictive walking device. • Inability to use swing and stance features of the knee unit. • Poor balance or ataxia that limits ambulation. • Significant hip flexion contracture (over 20◦). • Significant deformity of remaining limb that would impair ability to stride. • Limited cardiovascular and/or pulmonary reserve or profound weakness. • Limited cognitive ability to understand gait sequencing or care requirements. • Long distance or competitive running. • Falls outside of recommended weight or height guidelines of manufacturer. • Specific environmental factors—such as excessive moisture or dust, or inability to charge the prosthesis. • Extremely rural conditions where maintenance ability is limited.

B. Indications for use of the microprocessor knee should include: • Adequate cardiovascular and pulmonary reserve to ambulate at variable cadence. • Adequate strength and balance in stride to activate the knee unit. • Should not exceed the weight or height restrictions of the device. • Adequate cognitive ability to master technology and gait requirements of device. • Hemi-pelvectomy through knee-disarticulation level of amputation, including bilateral; lower extremity amputees are candidates if they meet functional criteria as listed. • Individual is an active walker and requires a device that reduces energy consumption to permit longer distances with less fatigue. • Daily activities or job tasks that do not permit full focus of concentration on knee control and stability—such as uneven terrain, ramps, curbs, stairs, repetitive lifting, and/or carrying. • Medicare Level K 2—limited community ambulator, but only if improved stability in stance permits increased independence, less risk of falls, and potential to advance to a less restrictive walking device, and individual has cardiovascular reserve, strength, and balance to use the prosthesis. The microprocessor enables fine-tuning and adjustment of the hydraulic mechanism to accommodate the unique motor skills and demands of the functional level K2 ambulator. • Medicare Level K 3—unlimited community ambulator. • Medicare Level K 4—active adult, athlete who has the need to function as a K 3 level in daily activities. • Potential to lessen back pain by providing more secure stance control, using less muscle control to keep knee stable. • Potential to unload and decrease stress on remaining limb. • Potential to return to an active lifestyle.

C. Physical and Functional Fitting Criteria for New Amputees: • New amputees may be considered if they meet certain criteria as outlined above. • Premorbid and current functional assessment important determinant. • Requires stable wound and ability to fit socket.

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• Immediate postoperative fit is possible. • Must have potential to return to active lifestyle.

A microprocessor-controlled knee is considered INVESTIGATIONAL in individuals who do not meet the above criteria.

A powered knee is considered INVESTIGATIONAL.

A microprocessor-controlled or powered foot is considered INVESTIGATIONAL.

Prior Authorization Information Inpatient • For services described in this policy, precertification/preauthorization IS REQUIRED if the procedure is performed inpatient.
Outpatient • For services described in this policy, see below for situations where prior authorization might be required if the procedure is performed outpatient.

Outpatient Commercial Managed Care (HMO and POS) Prior authorization is required. Commercial PPO
Prior authorization is required.

Requesting Prior Authorization Using Authorization Manager Providers will need to use Authorization Manager to submit initial authorization requests for services. Authorization Manager, available 24/7, is the quickest way to review authorization requirements, request authorizations, submit clinical documentation, check existing case status, and view/print the decision letter. For commercial members, the requests must meet medical policy guidelines.
To ensure the service request is processed accurately and quickly: • Enter the facility’s NPI or provider ID for where services are being performed. • Enter the appropriate surgeon’s NPI or provider ID as the servicing provider, not the billing group.

Authorization Manager Resources Refer to our Authorization Manager page for tips, guides, and video demonstrations. CPT Codes / HCPCS Codes / ICD Codes Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable.

The following codes are included below for informational purposes only; this is not an all-inclusive list. The above medical necessity criteria MUST be met for the following codes to be covered for Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity:

HCPCS Codes HCPCS codes: Code Description L5615 Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial, fluid swing and stance phase control

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L5856 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type L5857 Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type L5858 Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type ICD-10-PCS Procedure Codes ICD-10-PCS procedure codes: Code Description F07Z9CZ Gait Training/Functional Ambulation Treatment using Mechanical Equipment F07Z9DZ Gait Training/Functional Ambulation Treatment using Electrotherapeutic Equipment F07Z9EZ Gait Training/Functional Ambulation Treatment using Orthosis F07Z9FZ Gait Training/Functional Ambulation Treatment using Assistive, Adaptive, Supportive or Protective Equipment F07Z9GZ Gait Training/Functional Ambulation Treatment using Aerobic Endurance and Conditioning Equipment F07Z9UZ Gait Training/Functional Ambulation Treatment using Prosthesis F07Z9YZ Gait Training/Functional Ambulation Treatment using Other Equipment F07Z9ZZ Gait Training/Functional Ambulation Treatment F0DZ6EZ Dynamic Orthosis Device Fitting using Orthosis F0DZ6FZ Dynamic Orthosis Device Fitting using Assistive, Adaptive, Supportive or Protective Equipment F0DZ6UZ Dynamic Orthosis Device Fitting using Prosthesis F0DZ6ZZ Dynamic Orthosis Device Fitting F0DZ7EZ Static Orthosis Device Fitting using Orthosis F0DZ7FZ Static Orthosis Device Fitting using Assistive, Adaptive, Supportive or Protective Equipment F0DZ7UZ Static Orthosis Device Fitting using Prosthesis F0DZ7ZZ Static Orthosis Device Fitting F0FZDEZ Caregiver Training in Application, Proper Use and Care of Devices using Orthosis F0FZDFZ Caregiver Training in Application, Proper Use and Care of Devices using Assistive, Adaptive, Supportive or Protective Equipment F0FZDUZ Caregiver Training in Application, Proper Use and Care of Devices using Prosthesis F0FZDZZ Caregiver Training in Application, Proper Use and Care of Devices F0FZFEZ Caregiver Training in Application, Proper Use and Care of Orthoses using Orthosis F0FZFFZ Caregiver Training in Application, Proper Use and Care of Orthoses using Assistive, Adaptive, Supportive or Protective Equipment F0FZFUZ Caregiver Training in Application, Proper Use and Care of Orthoses using Prosthesis F0FZFZZ Caregiver Training in Application, Proper Use and Care of Orthoses F0FZGEZ Caregiver Training in Application, Proper Use and Care of Prosthesis using Orthosis F0FZGFZ Caregiver Training in Application, Proper Use and Care of Prosthesis using Assistive, Adaptive, Supportive or Protective Equipment F0FZGUZ Caregiver Training in Application, Proper Use and Care of Prosthesis using Prosthesis F0FZGZZ Caregiver Training in Application, Proper Use and Care of Prosthesis

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The following HCPCS codes are considered investigational for Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity:

HCPCS Codes HCPCS codes: Code Description L2221 Addition to lower extremity orthosis, ankle system, microprocessor-controlled feature plantarflexion and/or dorsiflexion, includes power source L5969 Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s) L5973 Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source L5992 All lower extremity prosthesis, foot shell for modular foot/non-solid ankle cushion heel (sach) replacement only

Description Lower-Extremity Prosthetics More than 100 different prosthetic ankle-foot and knee designs are currently available. The choice of the most appropriate design may depend on the patient’s underlying activity level. For example, the requirements of a prosthetic knee in an elderly, largely homebound individual will differ from those of a younger, active person. Key elements of prosthetic knee design involve providing stability during both the stance and swing phase of the gait. Prosthetic knees vary in their ability to alter the cadence of the gait, or the ability to walk on rough or uneven surfaces. In contrast to more simple prostheses, which are designed to function optimally at 1 walking cadence, fluid and hydraulic-controlled devices are designed to allow amputees to vary their walking speed by matching the movement of the shin portion of the prosthesis to the movement of the upper leg. For example, the rate at which the knee flexes after “toe-off” and then extends before heel strike depends in part on the mechanical characteristics of the prosthetic knee joint. If the resistance to flexion and extension of the joint does not vary with gait speed, the prosthetic knee extends too quickly or too slowly relative to the heel strike if the cadence is altered. When properly controlled, hydraulic or pneumatic swing-phase controls allow the prosthetist to set a pace adjusted to the individual amputee, from very slow to a race-walking pace. Hydraulic prostheses are heavier than other options and require gait training; for these reasons, these prostheses are prescribed for athletic or fit individuals. Other design features include multiple centers of rotation, referred to as “polycentric knees.” The mechanical complexity of these devices allows engineers to optimize selected stance and swing-phase features.

Summary Microprocessor-controlled prostheses use feedback from sensors to adjust joint movement on a real-time as-needed basis. Active joint control is intended to improve safety and function, particularly for patients who can maneuver on uneven terrain and with variable gait.

Summary of Evidence For individuals who have a transfemoral amputation who receive a prosthesis with a microprocessor- controlled knee, the evidence includes a number of within-subject comparisons of microprocessor- controlled knees versus non-microprocessor-controlled knee joints and systematic reviews of these studies. Relevant outcomes are functional outcomes, health status measures, and quality of life. For K3- and K4-level amputees, studies have shown an objective improvement in function on some outcome measures, particularly for hill and ramp descent, and strong patient preference for microprocessor- controlled prosthetic knees. Benefits include a more normal gait, increased stability, and a decrease in falls. The evidence in Medicare level K2 ambulators suggests that a prosthesis with stance control only can improve activities that require balance and improve walking in this population. For these reasons, a microprocessor-controlled knee may provide incremental benefit for these individuals. The potential to achieve a higher functional level with a microprocessor-controlled knee includes having the appropriate

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physical and cognitive ability to use the advanced technology. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have a transfemoral amputation who receive a prosthesis with a powered knee, the evidence includes no data. Relevant outcomes are functional outcomes, health status measures, and quality of life. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have a tibial amputation who receive a prosthesis with a microprocessor-controlled ankle-foot, the evidence includes limited data. Relevant outcomes are functional outcomes, health status measures, and quality of life. The limited evidence available to date does not support an improvement in functional outcomes using microprocessor-controlled ankle-foot prostheses compared with standard prostheses although quality of life improvements were noted in 1 small study. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have a tibial amputation who receive a prosthesis with a powered ankle-foot, the evidence includes limited data. Relevant outcomes are functional outcomes, health status measures, and quality of life. The limited evidence available to date does not support an improvement in functional outcomes using powered ankle-foot prostheses compared with standard prostheses. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

Policy History Date Action 4/2026 Policy updated with literature review through January 20, 2026; references added. Policy statements unchanged. 4/2026 Clarified coding information. 5/2025 Annual policy review. References updated. Policy statements unchanged. 5/2024 Annual policy review. References updated. Policy statements unchanged. 1/2024 Clarified coding information. 9/2023 Policy clarified to include prior authorization requests using Authorization Manager.
5/2023 Annual policy review. Minor editorial refinements to policy statements; intent unchanged. 6/2022 Prior authorization information clarified for PPO plans. Effective 6/1/2022. 4/2022 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 4/2021 Annual policy review. Policy statements unchanged. 4/2021 Clarified coding information. 1/2021 Medicare information removed. See MP #132 Medicare Advantage Management for local coverage determination and national coverage determination reference.
5/2020 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 4/2019 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 6/2018 Annual policy review. Background and summary clarified. 1/2018 Coding information clarified. 11/2016 Annual policy review. Policy updated to align patient selection and identification guideline with National policy. Effective 11/1/2016. 9/2016 Clarified coding information. 11/2015 Added coding language. 6/2015 New references added from Annual policy review. 6/2014 Updated Coding section with ICD10 procedure and diagnosis codes. Effective 10/2015. 5/2014 Annual policy review. New references added. 1/2014 Updated to add new HCPCS code L5969.

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5/2013 Annual policy review. New references added. 11/2011-4/2012 Medical policy ICD 10 remediation: Formatting, editing and coding updates. No changes to policy statements.
9/01/2010 Updated to require prior authorization for commercial products for this service.
5/18/2010 Annual policy review. New references added 11/1/2009
New policy, effective 11/1/2009, describing covered and non-covered indications.
Information Pertaining to All Blue Cross Blue Shield Medical Policies Click on any of the following terms to access the relevant information: Medical Policy Terms of Use Managed Care Guidelines Indemnity/PPO Guidelines Clinical Exception Process Medical Technology Assessment Guidelines

References

1. Flynn K. Short Report: Computerized lower limb prosthesis (VA Technology Assessment Program). No. 2. Boston, MA: Veterans Health Administration; 2000.
2. Thibaut A, Beaudart C, Maertens DE Noordhout B, et al. Impact of microprocessor prosthetic knee on mobility and quality of life in patients with lower limb amputation: a systematic review of the literature. Eur J Phys Rehabil Med. Jun 2022; 58(3): 452-461. PMID 35148043
3. Hahn A, Bueschges S, Prager M, et al. The effect of microprocessor controlled exo-prosthetic knees on limited community ambulators: systematic review and meta-analysis. Disabil Rehabil. Dec 2022; 44(24): 7349-7367. PMID 34694952
4. Morgan SJ, Friedly JL, Nelson IK, et al. The effects of microprocessor prosthetic knee use in early rehabilitation: A pilot randomized controlled trial. PM R. Apr 2025; 17(4): 371-383. PMID 39895150
5. Wurdeman SR, Hafner BJ, Sawers A, et al. ASsessing Clinical outcomes with microprocEssor kNee uTilization in a K2 population (ASCENT K2): randomized controlled trial results for above-knee prosthesis users over age 65. Disabil Rehabil. Mar 2026; 48(5): 1476-1493. PMID 40686456
6. Theeven P, Hemmen B, Rings F, et al. Functional added value of microprocessor-controlled knee joints in daily life performance of Medicare Functional Classification Level-2 amputees. J Rehabil Med. Oct 2011; 43(10): 906-15. PMID 21947182
7. Theeven PJ, Hemmen B, Geers RP, et al. Influence of advanced prosthetic knee joints on perceived performance and everyday life activity level of low-functional persons with a transfemoral amputation or knee disarticulation. J Rehabil Med. May 2012; 44(5): 454-61. PMID 22549656
8. Burnfield JM, Eberly VJ, Gronely JK, et al. Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees. Prosthet Orthot Int. Mar 2012; 36(1): 95-104. PMID 22223685
9. Orendurff MS, Segal AD, Klute GK, et al. Gait efficiency using the C-Leg. J Rehabil Res Dev. 2006; 43(2): 239-46. PMID 16847790
10. Klute GK, Berge JS, Orendurff MS, et al. Prosthetic intervention effects on activity of lower-extremity amputees. Arch Phys Med Rehabil. May 2006; 87(5): 717-22. PMID 16635636
11. Williams RM, Turner AP, Orendurff M, et al. Does having a computerized prosthetic knee influence cognitive performance during amputee walking?. Arch Phys Med Rehabil. Jul 2006; 87(7): 989-94. PMID 16813788
12. Hafner BJ, Smith DG. Differences in function and safety between Medicare Functional Classification Level-2 and -3 transfemoral amputees and influence of prosthetic knee joint control. J Rehabil Res Dev. 2009; 46(3): 417-33. PMID 19675993
13. Highsmith MJ, Kahle JT, Miro RM, et al. Ramp descent performance with the C-Leg and interrater reliability of the Hill Assessment Index. Prosthet Orthot Int. Oct 2013; 37(5): 362-8. PMID 23327837
14. Howard CL, Wallace C, Perry B, et al. Comparison of mobility and user satisfaction between a microprocessor knee and a standard prosthetic knee: a summary of seven single-subject trials. Int J Rehabil Res. Mar 2018; 41(1): 63-73. PMID 29293160

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15. Hafner BJ, Willingham LL, Buell NC, et al. Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee. Arch Phys Med Rehabil. Feb 2007; 88(2): 207-17. PMID 17270519
16. Kaufman KR, Bernhardt KA, Symms K. Functional assessment and satisfaction of transfemoral amputees with low mobility (FASTK2): A clinical trial of microprocessor-controlled vs. non- microprocessor-controlled knees. Clin Biomech (Bristol). Oct 2018; 58: 116-122. PMID 30077128
17. Kaufman KR, Levine JA, Brey RH, et al. Gait and balance of transfemoral amputees using passive mechanical and microprocessor-controlled prosthetic knees. Gait Posture. Oct 2007; 26(4): 489-93. PMID 17869114
18. Kaufman KR, Levine JA, Brey RH, et al. Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees. Arch Phys Med Rehabil. Jul 2008; 89(7): 1380-5. PMID 18586142
19. Johansson JL, Sherrill DM, Riley PO, et al. A clinical comparison of variable-damping and mechanically passive prosthetic knee devices. Am J Phys Med Rehabil. Aug 2005; 84(8): 563-75. PMID 16034225
20. Carse B, Scott H, Brady L, et al. Evaluation of gait outcomes for individuals with established unilateral transfemoral amputation following the provision of microprocessor controlled knees in the context of a clinical service. Prosthet Orthot Int. Jun 01 2021; 45(3): 254-261. PMID 34016870
21. Alzeer AM, Bhaskar Raj N, Shahine EM, et al. Impacts of Microprocessor-Controlled Versus Non- microprocessor-Controlled Prosthetic Knee Joints Among Transfemoral Amputees on Functional Outcomes: A Comparative Study. Cureus. Apr 2022; 14(4): e24331. PMID 35607529
22. Best TK, Seelhoff CA, Wensman J, et al. The clinical effects of the Össur Power Knee with phase- based and default control during sitting, standing, and walking. J Neuroeng Rehabil. Sep 29 2025; 22(1): 200. PMID 41024213
23. Zhou S, Kestur S, Maldonado J, et al. "Comparing the biomechanical response of users of an open- source powered knee and ankle prosthesis versus a passive prosthesis during ramp and stair ambulation". J Biomech. Jun 2025; 186: 112732. PMID 40300430
24. Hofstad C, Linde H, Limbeek J, et al. Prescription of prosthetic ankle-foot mechanisms after lower limb amputation. Cochrane Database Syst Rev. 2004; 2004(1): CD003978. PMID 14974050
25. Alimusaj M, Fradet L, Braatz F, et al. Kinematics and kinetics with an adaptive ankle foot system during stair ambulation of transtibial amputees. Gait Posture. Oct 2009; 30(3): 356-63. PMID 19616436
26. Fradet L, Alimusaj M, Braatz F, et al. Biomechanical analysis of ramp ambulation of transtibial amputees with an adaptive ankle foot system. Gait Posture. Jun 2010; 32(2): 191-8. PMID 20457526
27. Darter BJ, Wilken JM. Energetic consequences of using a prosthesis with adaptive ankle motion during slope walking in persons with a transtibial amputation. Prosthet Orthot Int. Feb 2014; 38(1): 5-
28. PMID 23525888
29. Gailey RS, Gaunaurd I, Agrawal V, et al. Application of self-report and performance-based outcome measures to determine functional differences between four categories of prosthetic feet. J Rehabil Res Dev. 2012; 49(4): 597-612. PMID 22773262
30. Delussu AS, Brunelli S, Paradisi F, et al. Assessment of the effects of carbon fiber and bionic foot during overground and treadmill walking in transtibial amputees. Gait Posture. Sep 2013; 38(4): 876-
31. PMID 23702342
32. Thomas-Pohl M, Villa C, Davot J, et al. Microprocessor prosthetic ankles: comparative biomechanical evaluation of people with transtibial traumatic amputation during standing on level ground and slope. Disabil Rehabil Assist Technol. Jan 2021; 16(1): 17-26. PMID 31535903
33. Colas-Ribas C, Martinet N, Audat G, et al. Effects of a microprocessor-controlled ankle-foot unit on energy expenditure, quality of life, and postural stability in persons with transtibial amputation: An unblinded, randomized, controlled, cross-over study. Prosthet Orthot Int. Dec 01 2022; 46(6): 541-
34. PMID 36515900
35. Au S, Berniker M, Herr H. Powered ankle-foot prosthesis to assist level-ground and stair-descent gaits. Neural Netw. May 2008; 21(4): 654-66. PMID 18499394
36. Ferris AE, Aldridge JM, Rábago CA, et al. Evaluation of a powered ankle-foot prosthetic system during walking. Arch Phys Med Rehabil. Nov 2012; 93(11): 1911-8. PMID 22732369
37. Herr HM, Grabowski AM. Bionic ankle-foot prosthesis normalizes walking gait for persons with leg amputation. Proc Biol Sci. Feb 07 2012; 279(1728): 457-64. PMID 21752817

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35. Mancinelli C, Patritti BL, Tropea P, et al. Comparing a passive-elastic and a powered prosthesis in transtibial amputees. Annu Int Conf IEEE Eng Med Biol Soc. 2011; 2011: 8255-8. PMID 22256259
36. Cacciola CE, Kannenberg A, Hibler KD, Howell J. Impact of a Powered Prosthetic Ankle-Foot Component on Musculoskeletal Pain in Individuals with Transtibial Amputation: A Real-World Cross- Sectional Study with Concurrent and Recalled Pain and Functional Ratings. J Prosthet Orthot. 2022. doi: 10.1097/JPO.0000000000000442.
37. VA/DOD Clinical Practice Guideline, Work Group. VA/DOD Clinical Practice Guideline for Rehabilitation of Individuals With Lower Limb Amputation. U.S. Government Printing Office; 2024:2-
38. https://www.healthquality.va.gov/guidelines/Rehab/amp/LLA-CPG_2024- Guidelinefinal20250110.pdf