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Using an updated PASS threshold of 66.7 for the International Knee Documentation Committee (IKDC) score previously established for this patient cohort, a univariate and multivariate analysis was performed to identify preoperative patient characteristics predictive of failure to achieve PASS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 197 patients with a mean follow\u2010up of 6.2\u2009\u00b1\u20092.1 years (range 2.7 \u2013 11.2) were included in the analysis (48.5\u2009\u00b1\u20095.6 years, 51.8% female, Body Mass Index (BMI) 25.9\u2009\u00b1\u20094.4). PASS was achieved by 162 patients (82.2%). Patients who failed to achieve PASS more often had lateral compartment cartilage defects (<jats:italic>P<\/jats:italic>\u2009=\u20090.001) and lateral meniscus tears (<jats:italic>P<\/jats:italic>\u2009=\u20090.004), higher BMIs (<jats:italic>P<\/jats:italic>\u2009=\u20090.004), and Workers\u2019 Compensation status (<jats:italic>P<\/jats:italic>\u2009=\u20090.043) on univariable analysis. Factors predictive of failure to achieve PASS on multivariable analysis included BMI and lateral compartment cartilage defect (OR 1.12 [1.03\u20131.23], <jats:italic>P<\/jats:italic>\u2009=\u20090.013; OR 5.1 [1.87\u201313.9], <jats:italic>P<\/jats:italic>\u2009=\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among patients\u2009\u2265\u200940 years who receive a primary allograft ACLR, patients who fail to achieve PASS more often had lateral compartment cartilage defects and higher BMIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07334-x","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T02:02:56Z","timestamp":1677031376000},"page":"3204-3211","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Preoperative factors associated with failure to reach the patient acceptable symptom state after anterior cruciate ligament reconstruction in patients aged 40 and older"],"prefix":"10.1002","volume":"31","author":[{"given":"Richard N.","family":"Puzzitiello","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Tufts Medical Center Tufts University School of Medicine 800 Washington St. # 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All other authors have nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study received IRB approval from Tufts Medical Center IRB. IRB number 12868.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}