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Bilateral knee MRI of 36 patients who underwent ACL reconstruction were performed before surgery, 6 months, 1 year, and 2 years, postoperatively. Postural stability was evaluated based on Y\u2010Balance Test at 1 and 2 years. ACL patients were also split into three groups based on postural stability symmetry at 2 years and symmetry thresholds associated with elevated risks of lower extremity injury. Voxel\u2010based relaxometry employing analysis of covariance was used to analyze localized differences in cartilage composition at all time\u2010points (using quantitative magnetic resonance [MR] T1\u03c1 and T2 mapping) between the three groups. The ACL patients displayed no significant deficits in postural stability. Compared with symmetric patients, those with asymmetric postural stability at 2 years had significantly prolonged cartilage T1\u03c1\u2014indicating deterioration of the cartilage matrix\u2014specifically in the injured knee's medial tibia as early as 6\u2010month post\u2010reconstruction. Prolonged T1\u03c1 in asymmetric patients persisted up to 2 years, where the group also reported worse KOOS. Our results demonstrate an association between early stages of cartilage matrix deterioration and postural stability symmetry that may manifest in elevated lower extremity injury risk and worse patient\u2010reported outcomes. Quantitative MR, in combination with local analysis performed with voxel\u2010based relaxometry, is a tool to further study this relationship. \u00a9 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. 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