Late but Not Too Late: Predictors of Full Neck Motion Following Surgical Correction of Congenital Muscular Torticollis in School-Going Children.

OBJECTIVE: To identify predictors of full cervical range of motion (ROM) following surgical sternocleidomastoid (SCM) release in school-age children with congenital muscular torticollis (CMT). DESIGN: Retrospective cohort study. SETTING: Tertiary referral pediatric orthopedic center. PARTICIPANTS: 44 children older than 5 years with ultrasonography-confirmed CMT, ≥ 6 months of failed physiotherapy, and ≥ 36 months of follow-up (median age 7.6 years, 57% boys). INTERVENTIONS: Standardized open surgical SCM release. MAIN OUTCOME MEASURES: Primary outcome was full ROM at 36 months, defined as active rotation and lateral flexion within 5° of age norms and absence of head tilt. Eight pre-specified variables were assessed using logistic regression. RESULTS: Full ROM was achieved in 29 children (66, 95% CI 51-79%) at a median of 4 months postoperatively. Mean lateral bending improved from 18.2° ± 4.6° to 36.9° ± 3.8° at 36 months (p < 0.001), within 3° of normal. On multivariate analysis, older age reduced odds of success by 21% per year (OR 0.79, 95% CI 0.64-0.98; p = 0.032), each 10° increase in preoperative rotation deficit reduced odds by 30% (OR 0.70, 95% CI 0.55-0.90; p = 0.006), and physiotherapy compliance ≥ 80% increased odds more than five-fold (OR 5.10, 95% CI 1.60-16.2; p = 0.006). The model showed good performance (AUC 0.85, Hosmer-Lemeshow p = 0.71). Complications were minimal (one superficial infection, one revision). CONCLUSION: Surgical SCM release provides durable correction in most school-age children with CMT. Younger age, smaller preoperative rotation deficit, and strong physiotherapy adherence predict optimal recovery. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-026-01846-7.