Study Objective To develop a risk score for surgically proven recurrent adnexal torsion (rAT), among women with a previous adnexal torsion proven surgically. Design A retrospective cohort study between 2011 and 2020. Setting A tertiary, university affiliated medical center. Patients or Participants All women with a history of surgically confirmed adnexal torsion, who underwent surgical diagnostic procedure due to a suspected rAT. Overall, 115 women were included. Interventions Operative laparoscopy. Measurements and Main Results We collected demographic and clinical characteristics, sonographic findings and laboratory results of all suspected rAT cases that subsequently underwent surgery. We compared cases with adnexal torsion to cases without, as confirmed by operative laparoscopy. Adnexal torsion was identified in 86 (74.8%) of the surgical procedures. Age and pregnancy rates were similar in both groups. Women with adnexal torsion had less prior pelvic surgeries (excluding prior adnexal torsion) [OR(95%CI) 0.24(0.09-0.59), p=0.001], prior oophoropexy [OR(95%CI) 0.36(0.13-0.97), p=0.04] or right adnexal tenderness [OR(95%CI) 0.21 (0.08-0.52), p After multivariate analysis, four risk factors remained significantly independently associated with adnexal torsion. Previous pelvic surgery [aOR(95%CI) 0.06(0.007-0.54), p=0.01] and right side pain [aOR(95%CI) 0.05(0.008-0.33), p=0.002] were negatively associated with adnexal torsion. A larger maximal diameter of the affected ovary [aOR(95%CI) 1.78(1.08-2.93), p=0.02] and enlarged ovary [aOR(95%CI) 7.40(1.28-42.59), p=0.02] were positively associated with adnexal torsion. Conclusion Our risk score enables to predict a true positive rAT that may assist clinicians in decision management in cases of suspected rAT.