This paper reviews the long-term consequences of anterior cruciate ligament (ACL) and meniscus injuries, focusing on the pathogenic mechanisms and the variability in outcomes. The authors highlight that 50% of individuals diagnosed with ACL or meniscus tears develop osteoarthritis (OA) 10-20 years later, often with significant pain and functional impairment. They note that there is limited evidence supporting the protective role of repair or reconstruction surgery against OA development. The review emphasizes the importance of understanding the multifactorial nature of OA, including systemic and local mechanical factors, and the role of individual variables such as age, sex, genetics, obesity, and muscle strength. The authors also discuss the challenges in evaluating treatment outcomes due to poor reporting and methodological issues in existing studies. They advocate for improved quality in future research, including large randomized clinical trials and well-designed observational studies, to better inform prevention and treatment strategies for ACL and meniscus injuries.This paper reviews the long-term consequences of anterior cruciate ligament (ACL) and meniscus injuries, focusing on the pathogenic mechanisms and the variability in outcomes. The authors highlight that 50% of individuals diagnosed with ACL or meniscus tears develop osteoarthritis (OA) 10-20 years later, often with significant pain and functional impairment. They note that there is limited evidence supporting the protective role of repair or reconstruction surgery against OA development. The review emphasizes the importance of understanding the multifactorial nature of OA, including systemic and local mechanical factors, and the role of individual variables such as age, sex, genetics, obesity, and muscle strength. The authors also discuss the challenges in evaluating treatment outcomes due to poor reporting and methodological issues in existing studies. They advocate for improved quality in future research, including large randomized clinical trials and well-designed observational studies, to better inform prevention and treatment strategies for ACL and meniscus injuries.