Twisted light with orbital angular momentum (OAM) has been extensively studied for applications in quantum and classical communications, microscopy, and optical micromanipulation. Ejecting high angular momentum states of a whispering gallery mode (WGM) microresonator through a grating-assisted mechanism provides a scalable, chip-integrated solution for OAM generation. However, demonstrated OAM microresonators have exhibited a much lower quality factor (Q) than conventional WGM resonators (by >100×), and an understanding of the limits on Q has been lacking. This is crucial given the importance of Q in enhancing light-matter interactions. Moreover, though high-OAM states are often desirable, the limits on what is achievable in a microresonator are not well understood. Here, we provide insight on these two questions, through understanding OAM from the perspective of mode coupling in a photonic crystal ring and linking it to coherent backscattering between counter-propagating WGMs. In addition to demonstrating high-Q (105 to 106), a high estimated upper bound on OAM ejection efficiency (up to 90%), and high-OAM number (up to l = 60), our empirical model is supported by experiments and provides a quantitative explanation for the behavior of Q and the upper bound of OAM ejection efficiency with l. The state-of-the-art performance and understanding of microresonator OAM generation opens opportunities for OAM applications using chip-integrated technologies.