Obturator-to-Femoral Nerve Transfer With Structured Physical Therapy: A Case Series

BACKGROUND: Femoral nerve palsy causes profound quadriceps weakness and gait instability. When direct repair is not feasible, obturator-to-femoral nerve transfer can improve knee extension, yet rehabilitation guidelines are undefined. CASE PRESENTATION: Three patients (ages 50–74) with femoral neuropathy underwent obturator-to-femoral nerve transfer followed by a structured, donor-activation–based rehabilitation program emphasizing progressive adduction–quadriceps co-contraction and gait retraining. OUTCOME AND FOLLOW-UP: All patients achieved meaningful reinnervation and independent ambulation. Quadriceps strength improved to Medical Research Council [MRC] 3– to 5–, and each progressed through the protocol to functional strengthening. Final outcomes included reciprocal stair climbing or step-to patterns, with endurance limited only by comorbid conditions. DISCUSSION: Consistent use of a phased rehabilitation framework after lower-extremity nerve transfer facilitated reproducible motor recovery and safe functional progression. Clinicians should emphasize early donor activation, gait mechanics, and individualized pacing. JOSPT Cases 2026;6(1):11-15. Epub 14 January 2026. doi:10.2519/josptcases.2026.0210