Wang X, et al. - Fifty-seven anterior cruciate ligament (a common knee injury that primarily affects young, active individuals) reconstruction (ACLR) patients aged 18–40 years who underwent knee magnetic resonance imaging were recruited in a study by the experts in order to assess osteoarthritis-related morphological change over 2 years in the tibiofemoral joint (TFJ) among individuals who underwent ACLR with or without concomitant meniscal pathology and in healthy controls and to investigate correlations of baseline TFJ cartilage defects and bone marrow lesions (BML) scores with tibial cartilage volume change in ACLR groups. For both ACLR groups, an elevation over 2 years in medial and lateral tibial cartilage volume was observed. In comparison with controls and with the combined group, isolated ACLR group had higher annual percentage rise in lateral tibial cartilage volume. Across all the groups, cartilage defects remained unaltered. In contrast to controls, both ACLR groups exhibited more lateral tibia BML regression. At lateral tibia, baseline cartilage defects score was positively correlated with cartilage volume increase while in the pooled ACLR group baseline BMLs score was inversely related to the medial tibial cartilage volume increase. Hence, from 2.5 to 4.5 years post-surgery, tibial cartilage hypertrophy was obvious in ACLR knees and was partially reliant upon meniscal status together with the nature and location of the underlying pathology at baseline. Moreover, the magnitude and direction of change in joint pathologies (i.e., cartilage defects, BMLs) were less predictable and either continued to be stable or enhanced over follow-up.