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 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.