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Background: To quantitatively and qualitatively assess vastus medialis muscle atrophy in asymptomatic patients with anterior cruciate ligament reconstruction, using the nonoperated leg as control. Methods: Prospective Institutional Review Board approved study with written informed patient consent. Thirty‐three asymptomatic patients (men, 21; women,12) with ACL‐reconstruction underwent MR imaging of both legs (axial T1‐weighted spin‐echo and 3D spoiled dual gradient‐echo sequences). Muscle volume and average fat‐signal fraction (FSF) of the vastus medialis muscles were measured. Additionally, Goutallier classification was used to classify fatty muscle degeneration. Significant side differences were evaluated using the Wilcoxon test and, between volumes and FSF, using student t‐tests with P‐value < 0.05 and < 0.025, respectively. Results: The muscle volume was significantly smaller in the …