PURPOSE: Although the occurrence of early osteoarthritis (OA) is commonly associated with a history of anterior cruciate ligament (ACL) reconstruction, its exact prevalence in these patients remains unknown. The goal of this study was to review the current literature on long-term radiographic outcome after autologous ACL reconstruction and subsequently perform a meta-analysis to obtain evidence-based prevalences of OA at a mean of 10 years after surgery. In addition, this report aimed at identifying the relationship between meniscal status and the occurrence of radiographic OA in the ACL reconstructed knee. METHODS: A systematic review of the literature was performed in PubMed MEDLINE, EMBASE and Cochrane Library databases to identify all studies concerning radiographic outcome after autologous ACL reconstruction with a follow-up of minimum 10 years. Meta-analyses were performed to obtain the average prevalence of OA and the difference between patients with and without meniscectomy. Considered study estimates were the log-transformed odds and odds ratios, the latter expressing the effect of meniscectomy on OA. RESULTS: A total of 16 studies could be included for meta-analysis, accounting for 1554 ACL reconstructions performed between 1978 and 1997. Of these knees, 453 (28 %) showed radiological signs of osteoarthritis (IKDC grade C or D). Furthermore, 50 % of the patients with meniscectomy had osteoarthritis, compared with 16 % of the patients without meniscectomy. The combined odds ratio for meniscectomy equals 3.54 (95 % CI 2.56-4.91). CONCLUSIONS: The main finding of this meta-analysis is that the prevalence of radiographic knee OA after ACL reconstruction is lower than commonly perceived. However, associated meniscal resection dramatically increases the risk for developing OA. LEVEL OF EVIDENCE: Level III.