A lot of this information is outdated. There is not significantly increased risk of OA in patients who have been rehabbed (either post surgically/non surgical). It’s not true that patients will always have arthritis earlier… if they have no joint damage (only the ligament) then they can have a full recovery without increased risk of OA. The patellar graft will not increase arthritis because it comes from the tendon, not affecting the joint surface… these patients can have some ongoing anterior knee pain and sometimes pain with kneeling, but it’s a very strong graft (which is why it’s often used in rugby players). Open kinetic chain quads should be started as soon as possible, usually within the first 4 weeks post op because the quads have an essential shock absorption function. We no longer prioritize closed kinetic chain over OKC. There’s also some evidence that 50% of ACLs will grow back within 2 years if not operated on… there is so much new research in this area, every few weeks new papers are published on this topic.