Objective To use superior rectus transposition （SRT） with adjustable medial rectus muscle recession for the treatment of sixth nerve palsy. Methods This was a retrospective clinical study. Eleven patients with sixth nerve palsy who underwent SRT in Tianjin Eye Hospital or the First People′s Hospital of Xuzhou were reviewed. The pre- and postoperative outcomes were compared and included the deviation angle of esotropia in the primary position， the head turn angle， and the limit of abduction. In the 11 cases， 8 patients had a medial rectus recession. Adjustable suture medial rectus recession was used to identify the proper positions. The average follow-up time was more than 6 months. Preoperative and postoperative first angle， angle of the compensatory head turn， limited extent of inside and outside duction were compared with a paired t test. Results Postoperatively， 10 patients showed orthophoria in the primary position and improved compensatory head turn. The patients were satisfied that there was no diplopia. One patient required a second surgery for under-correction. Compensatory head turn and diplopia were corrected after inferior rectus temporal transposition. In the 11 patients， esotropia improved from 31.2°±13.7° to 3.4°±1.7° （t=7.28， P<0.01）； compensatory head turn improved from 26.1°±7.7° to 0.9°±3.0° （t=10.75， P<0.01）； the abduction limit decreased from -4.8±0.9 to -2.0±0.9 （t=8.84， P<0.01） while the adduction limit increased from -0.2±0.4 to -1.0±0.4 （t=4.62， P<0.05）. No new vertical or torsional deviation was observed in any of the 11 patients. Conclusion Superior rectus transposition with medial rectus recession can be performed during the same surgery， avoiding the risk of anterior segment ischemia. SRT does not induce new vertical or torsional strabismus. Therefore， SRT with medial rectus recession is an effective approach to treat sixth nerve palsy.