The gastrocnemius muscle rotation flap is a utilitarian procedure for management of soft-tissue defects about the knee. Ten patients underwent medial gastrocnemius muscle rotation flaps at our institution during a 24-month period. Four of the 10 patients underwent primary muscle rotation-plasty for reconstruction following tumor resection; 3 patients had soft-tissue defects following trauma; 2 patients had skin ischemia following total knee arthroplasty; and 1 patient had a soft-tissue defect from scar formation. All procedures were performed by an orthopaedic surgeon. At follow-up of 6 to 24 months, the soft-tissue coverage was maintained in all patients. All of the muscle rotation flaps survived. The gastrocnemius rotation flap provides reliable anterior knee soft-tissue coverage and can be performed by most orthopaedic surgeons.