Back to 2026 Abstracts
Functional Outcomes After Obturator to Femoral Nerve Transfer in Femoral Nerve Palsy
Victoria V. Szymkiewicz
*1, Lahin Amlani
2, Fares Lebbos
3, Arman Zadeh
3, Aiko Puerto
3, Allan Belzberg
4, Sami Tuffaha
31School of Medicine, Johns Hopkins, Baltimore, MD; 2Department of Orthopaedic Surgery, Johns Hopkins, Baltimore, MD; 3Department of Plastic and Reconstructive Surgery, Johns Hopkins, Baltimore, MD; 4Department of Neurosurgery, Johns Hopkins, Baltimore, MD
Background: Femoral nerve palsy (FNP) is a rare but functionally devastating condition characterized by partial or complete loss of knee extension. Reconstructive options remain limited, but obturator to femoral nerve transfer may confer a biological advantage due to short regeneration distance. Existing literature consists of heterogeneous case series and isolated case reports, precluding analysis of obturator nerve transfers alone. This 7-patient case series evaluates clinical and functional outcomes of obturator to femoral nerve transfer for FNP.
Methods: A retrospective chart review of consecutive patients at a single institution was performed. Inclusion criteria required FNP diagnosis, obturator to femoral nerve transfer, and ≥ 18 months follow-up. Demographics, etiology, injury-to-surgery interval, and surgical details were recorded. The primary outcome was postoperative Medical Research Council (MRC) grade for knee extension.
Results: Seven patients met inclusion criteria. Average age at surgery was 40.2 ± 19.8 years. The majority of cases were tumor related (n=5, 71.4%). Excluding 2 chronic cases of FNP secondary to perineurioma, the mean injury-to-surgery interval of 23.1 ± 39.6 months. Average follow-up was 37.2 ± 20.1 months.
All patients demonstrated maintenance or improvement in knee extension strength, with mean improvement of 2 MRC grades. Six patients (85.7%) achieved an MRC grade ≥ 4, and one improved to MRC grade 3. All patients achieved full knee extension range of motion. There were no major perioperative complications or reoperations.
Conclusion: Obturator to femoral nerve transfer appears to be a safe and effective reconstructive option for FNP, resulting in meaningful restoration of knee extension and preserved joint motion. This technique may be advantageous in delayed presentations, proximal injuries, or cases requiring long regeneration distances. These findings support nerve transfer as an important option in the surgical management of FNP, offering patients reliable functional recovery with minimal morbidity.
Patient Demographics and Outcomes
| Patient | Age (years) | Sex | BMI (kg/m2) | Etiology | Injury to surgery interval (months) | Nerve transfer specifics | Pre-operative KE MRC grade | F/U time (months) | F/U KE MRC grade | Complications |
| 1 | 48.53 | Male | 29.29 | Tumor | 93.7 | gracilis branch to rectus femoris branch | 4 | 30.19 | 4 | minor self-limiting hematoma post-operatively |
| 2 | 18.50 | Female | 31.3 | Tumor* | chronic | gracilis branch to proximal femoral nerve branch before trifurcation | 2 | 74.13 | 3 | None |
| 3 | 61.84 | Male | 27.1 | Iatrogenic | 8.2 | gracilis branch to rectus femoris branch | 1 | 35.57 | 4 | None |
| 4 | 22.64 | Female | 20.35 | Tumor | 1.8 | gracilis branch to vastus lateralis branch | 0 | 23.73 | 4 | None |
| 5 | 47.62 | Female | 21.3 | IVDU Overdose | 6.6 | gracilis branch to vastus medialis and vastus intermedius branches | 1 | 18.33 | 4 | fluid collection at surgical site managed with drainage |
| 6 | 63.22 | Male | 23.04 | Tumor | 5.0 | gracilis branch to rectus femoris and vastus medialis branches | 3 | 54.3 | 4 | None |
| 7 | 19.23 | Female | 30.8 | Tumor* | chronic | gracilis branch to vastus medialis branch | 2 | 23.9 | 4 | None |
*Patient suffered from perineurioma
KE: Knee extension
BMI: Body Mass Index
IVDU: Intravenous drug use
F/U: Follow-up
MRC: Medical Research Council
Back to 2026 Abstracts
