To examine differences in cartilage morphology between young adults 2-3 years post-anterior cruciate ligament reconstruction (ACLR), with or without meniscal pathology, and control participants.Knee MRI was performed on 130 participants aged 18-40 years (62 with isolated ACLR, 38 with combined ACLR and meniscal pathology, and 30 healthy controls). Cartilage defects, cartilage volume and bone marrow lesions (BMLs) were assessed from MRI using validated methods.Cartilage defects were more prevalent in the isolated ACLR (69 %) and combined group (84 %) than in controls (10 %, P < 0.001). Furthermore, the combined group showed higher prevalence of cartilage defects on medial femoral condyle (OR 4.7, 95 % CI 1.3-16.6) and patella (OR 7.8, 95 % CI 1.5-40.7) than the isolated ACLR group. Cartilage volume was lower in both ACLR groups compared with controls (medial tibia, lateral tibia and patella, P < 0.05), whilst prevalence of BMLs was higher on lateral tibia (P < 0.001), with no significant differences between the two ACLR groups for either measure.Cartilage morphology was worse in ACLR patients compared with healthy controls. ACLR patients with associated meniscal pathology have a higher prevalence of cartilage defects than ACLR patients without meniscal pathology. The findings suggest that concomitant meniscal pathology may lead to a greater risk of future OA than isolated ACLR.III.