Background <p>Ovarian torsion is a surgical emergency that can threaten ovarian viability and future fertility. Long-term functional recovery and predictors of postoperative atrophy remain incompletely defined in children.</p> Objective <p>To evaluate long-term follicular development and ovarian atrophy after pediatric ovarian torsion and to assess the influence of torsion severity and surgical approach.</p> Methods <p>We retrospectively reviewed records of patients aged 0–18 years treated for ovarian torsion at our center between August, 2019 and August, 2022. Data included age group, laterality, symptom timing, torsion degree, operative technique, pathology, postoperative ultrasound follicular presence, and atrophy. Statistical tests were performed using IBM SPSS Statistics v25. A ROC analysis was used to explore rotation thresholds associated with atrophy. Statistical significance was defined as <i>p</i> &lt; 0.05.</p> Results <p>Forty-three patients were included; torsion was more frequent on the right ovary. Detorsion alone was performed in 17 patients, detorsion plus oophoropexy in 16, oophorectomy in 2, and salpingo-oophorectomy in 8. Among patients with postoperative ultrasound follow-up, follicular development was observed in 90% of those undergoing oophoropexy, with no significant difference compared with those without oophoropexy (<i>p</i> = 0.46). Atrophy was more frequent in torsions with 720 or more twisted ovaries (<i>p</i> = 0.01). ROC analysis suggested 900 degrees as a clinically relevant cut-off for increased atrophy risk.</p> Conclusion <p>In this single-center cohort, ovarian-sparing surgery achieved high follicular recovery. Torsion rotation severity was strongly associated with postoperative atrophy, with higher risk beyond approximately 900 degrees. Oophoropexy did not adversely affect follicular development, while its protective effect against atrophy remains uncertain.</p>