All right, I want to, again, thank you all and thank you to the MOON Group for the opportunity to present our data. Everybody's disclosures are updated through the academy. The MOON Group is an NIH-funded consortium which prospectively enrolled patients undergoing ACL reconstruction. The overall goal of this effort was to identify risk factors for poor outcomes after ACL reconstruction. Low rates of return to pre-injury activity after ACL reconstruction have been observed amongst multiple series, particularly among highly active patients. Previous reports have identified several risk factors for an inability to return to a pre-injury level of activity. These include female sex, high BMI, and low pre-injury activity level. The strength of previous conclusions is limited by relatively small cohorts and inconsistent definitions of patient's activity levels. The MARC's activity score has been used to characterize the extent of patient's baseline participation and activities of increasing demands. The purpose of the current study was to employ multivariable modeling to identify predictors of an individual's return to pre-injury level of activity after ACL reconstruction among a subset of highly active patients. We hypothesized that age, sex, pre-injury activity level, meniscal injuries and or procedures, concurrent articular cartilage injuries and procedures would predict return to pre-injury level of activity at two years after ACL surgery. This cohort included adult subject age 17 to 51. We defined highly active as a MARC's activity scale between 12 and 16 points and employed predictive multivariable modeling to determine and identify risk factors that predicted the inability to return to activity. Inability to return to activity was defined as a decrease in two-year follow-up MARC's activity score of greater than two points from the pre-injury level. For example, patient A with a pre-injury MARC's activity score of 16 endorses a MARC's activity score of 14 at two-year follow-up would be able to return to activity. Conversely, patient B with a pre-injury MARC's activity score of 14 that then subsequently reported a score of 11 at final follow-up would not be able to return to activity. Of the 1,437 patients eligible for inclusion, 1,118 patients completed two-year follow-up for 83% follow-up at two years. There was a preponderance of males in the series. Overall 54% of the 1,188 patients reported a maximum MARC's activity score of 16 at the time of injury. Overall 39 patients were able to return to their pre-injury level of activity after two years of ACL reconstruction. Negative predictors of an inability to return to pre-injury activity level included sex, smoking status, education, baseline activity score and mental health as represented by an SF-36 MCS. For patients with 12 years of education, there was a consistent decline in the likelihood of returning to activity. For patients with 16 years of education or a college education, older patients were more likely to return to activity at a certain inflection point. The higher the pre-injury MARC's activity score, the less likely that patient was to return to their pre-injury level of activity. The higher the pre-injury mental health score, the more likely those patients were to return to their pre-injury level of activity. This is the largest cohort of patients with a high pre-injury level of activity with this magnitude of follow-up. The majority of the adult patients, 61%, were unable to return to their pre-injury level of activity following ACL reconstruction at two years. The presence of concomitant meniscus and or chondral pathology and procedures had no effect on the likelihood of predicting. Patient age education level had a variable effect. Smoking and mental health status were the only potentially modifiable risk factors to predict the ability to return to pre-injury level of activity. So these data pretty convincingly demonstrate the extent to which patients with a high baseline activity are difficult to treat. The higher the pre-injury MARC's activity score, the less likely he or she was able to return to their pre-injury level of activity. Thank you.

MOON Group

ACL reconstruction

risk factors

pre-injury activity level

return to activity