The purpose of this study was to conduct an up-to-date systematic review and meta-analysis of radiographic knee osteoarthritis (OA) over minimal ten years after ACL reconstruction. The database of Pubmed and the Ovid was adopted. The radiographic knee OA over minimal ten years after ACL reconstruction was systematically reviewed. Both the ipsilateral and contralateral knees were evaluated referring to the tibiofemoral joint (TFJ), the patellofemoral joint (PFJ), and the overall knee OA prevalence. Nineteen studies were included for review, with nine screened for the meta-analysis. The overall knee OA rate ranged from 8.3–79.2%, meanly 51.6% on the ipsilateral side; ranged from 3.6–35.7%, meanly 15.5% on the contralateral side. Compared to the contralateral side, the RR of developing radiographic OA was 3.73 (P<0.01) for the overall knee, 2.88 (P<0.01) for TFJ, and 2.42 (P<0.01) for PFJ. Ipsilaterally, the RR of developing TFJ radiographic OA was 1.15 (P<0.01) compared to that of the PFJ. Over a minimum of 10 years after surgery, more than half the cases developed overall radiographic OA on the ipsilateral knee, which was nearly four times higher than the contralateral side. On the ipsilateral knee, the TFJ was most affected.