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Introduction Running may accelerate knee osteoarthritis development after knee surgery. We aimed to i) describe the prevalence of structural features associated with knee osteoarthritis on magnetic resonance imaging (MRI) in runners with versus without knee surgery history; ii) assess the association of MRI-defined osteoarthritis with knee surgery history and; iii) explore within-group sex differences.Materials and Methods Baseline knee MRIs from 203 runners (averaging ≥3 runs and ≥10km distance per week over the past 6 months, 105 with knee surgery history) were assessed using the MRI Osteoarthritis Knee Score. Prevalence of structural features (e.g., cartilage, osteophytes, bone marrow lesions, and meniscal pathology) in the patella, trochlear, femur and tibia were reported. Logistic regression assessed the association of surgical history with: i) MRI-defined osteoarthritis; and ii) assessed within-group sex differences.Results Patella cartilage (~43%) and bone marrow (~23%) lesion prevalence was similar in runners with versus without knee surgery history. Prevalence of cartilage lesions across the trochlear (34% vs 12%), femoral (38% vs 14%) and tibial (21% vs 3%) regions was greater in knees with surgery history. Knee surgery history was associated with four times higher odds of MRI-defined osteoarthritis (39% vs 13%; OR: 4.20, 95%CI 2.07–8.46). Prevalence rates were similar between sexes.Conclusion Runners with and without knee surgery history have similar prevalence of cartilage and bone marrow lesions in the patella. Cartilage lesions were greater for runners with knee surgery history across all other regions, as was the prevalence and likelihood of osteoarthritis. Sex differences were not apparent.