Good afternoon. I hope you're enjoying your time in my relatively new hometown On behalf of the Mars group I'd like to thank the AOSSM and a program committee for the opportunity to present this study Listed are the Mars group surgeon authors of this study Listed are the research coordinators and local site support staff for the Mars surgeons Conflicts of interest for the Mars group in this study are listed Revision anterior cruciate ligament reconstruction has consistently had worse outcomes than primary ACL reconstruction Little level one or prospective evidence is available regarding this topic based on these poor results The Mars group was formed to determine potentially modifiable predictors of outcome The AOSSM board and the research committee strongly supported the concept Participation was offered to all AOSSM members and over a hundred surgeons participated in training and design sessions Currently 83 surgeons are active at 52 IRB approved sites. It's a 50-50 mix of academic and private practice surgeons Previous studies from this cohort have demonstrated important findings that impact outcome for the revision ACL reconstruction patient This included our 2014 study that demonstrated autographed choice in the revision setting decreased re rupture and improved sports patient reported outcomes Previously, we reported the impact of meniscus and chondral damage with the worst outcome a history of previous lateral meniscectomy Or current trochlear group chondrosis noted at the time of revision ACL reconstruction As this systematic review demonstrated there is little data at or beyond five-year follow-up regarding the results of revision ACL reconstruction This demonstrates the significance of following the Mars cohort For this study we hypothesize surgical factors under the control the surgeon can both negatively and positively impact revision ACL reconstruction outcome Enrollment began in 2006 with baseline demographics surgical techniques and findings and patient reported outcomes obtained at baseline two and six years Multivariable analysis was utilized to determine if surgical factors predicted outcome number of variables as expected were included 1234 subjects were enrolled 58% were male. The median age was 26 years with a range of 12 to 63 We obtained overall 77% follow-up documenting re rupture and subsequent surgeries For this study, we focused on three broad areas of surgical factors approach and tunnel position fixation and biological factors a Trans tibial approach versus an anthromedial portal approach resulted in improved Coos and Womack subscale scores for pain quality of life and stiffness Marks activity was improved by a and portal Interestingly tunnels considered less than optimal or blended resulted in improved results Femoral or tibial fixation not using a metal screw resulted in worse scores for a variety of patient reported outcomes Biologic enhancement did not impact outcomes or graft re rupture at six years Secondary variables that improved outcome included higher baseline scores not smoking and lower BMI The most consistent drivers of outcome were ideal tunnel tibial tunnel predicted worse outcomes and interference screw use predicted improved scores The Study and cohort have many strengths this demonstrates Mars ability to quickly accumulate a large cohort that eclipses in one study the entirety of all previously accumulated patients with a six-year follow-up in the literature the 60-40 split of private practice and academic surgeons makes the results generalizable to the sports medicine community The cohort size allows multivariable regression modeling with a high number of variables The Results of this study raised many questions It's difficult to understand cause and effect for many of these factors Surgeons need to use this data to help drive decision-making in these complex surgical revision cases Want to acknowledge the NIH for its ongoing support of this cohort? Thank you

revision anterior cruciate ligament reconstruction

Mars group

modifiable predictors of outcome

autograft choice

surgical factors