36 ambulatory children with spastic diplegia (GMFCS level I-III) were assigned to single-event multilevel surgery (SEMLS) with either distal rectus femoris transfer (DRFT) or without it. In 1 year follow-up, DRFT group improved more in range of motion during swing and knee flexion velocity than the Non-DRFT group. However, nonresponder rate was 33% in the DRFT group. 53% of the Non-DRFT patients did not require secondary unnecessary DRFT surgery. Also patients with severe flexed-knee gait (normal or increased peak knee flexion in swing, pKFSw) did not benefit from DRFT procedure.