OBJECTIVE:To identify the consequences of an anterior cruciate ligament (ACL) tear in a cohort of male soccer players 14 years after the initial injury with respect to radiographic knee osteoarthritis and patient relevant outcomes. METHODS:Of 219 male soccer players with an ACL injury in 1986, 205 (94%) were available for follow up after 14 years; 75% of the cohort (154/205) answered mailed questionnaires (KOOS, SF-36, and Lysholm knee scoring scale) and 122 of these consented to weight bearing radiographs. RESULTS:Radiographic changes were found in 95 (78%) of the injured knees, while more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in 50 (41%). In the uninjured knees more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in five knees (4%). No differences were seen between surgically and conservatively treated players. The patient relevant outcome was affected and did not differ between subjects with and without radiographic changes. Eighty per cent reported reduced activity level. CONCLUSIONS:A high prevalence of radiographic knee osteoarthritis was seen in male soccer players 14 years after an ACL disruption. The injury and the osteoarthritis, irrespective of the treatment provided to these patients, often result in knee related symptoms that severely affect the knee related quality of life by middle age.