Optimal Period for Surgery for Congenital Muscular Torticollis Following the Failure of Physiotherapy

Congenital muscular torticollis is the third most common cause of orthopedic deformity. It is a risk factor for plagiocephaly. Physiotherapy is the preferred treatment. However, if it fails, surgery is recommended. This study examined the surgical results of congenital muscular torticollis in association with age. A retrospective descriptive study of patients who underwent surgery (tenotomy of the sternocleidomastoid muscle) for congenital muscular torticollis at a single center between 2000 and 2022 was, accordingly, performed. Clinical results (excellent, good, or poor) were examined in the following 3 age groups: younger than 18 months, older than 4 years, and an intermediate age. Surgical results were evaluated for at least 12 months of follow-up. During the study period, 96 cases of congenital muscular torticollis were surgically treated, and 75 records met the inclusion criteria. Initial physiotherapy was administered to all patients for an average of 16.9 months. Excellent and good results were better in the below 18-month group (mean: 13.4 mo) without recurrence. The results were poor in 22.8% of intermediate-age patients and in 13.0% of those older than 4 years. Thus, surgery for congenital muscular torticollis, after the failure of physiotherapy, achieved an overall success rate of 85.6% (excellent or good). Bipolar tenotomy should, therefore, be performed if congenital muscular torticollis is resistant to physiotherapy. The optimal period is between 12 and 18 months of age. In cases of neglected torticollis, better results are obtained if surgery is postponed until after the child is 4 years old. Level of evidence: level III.