Abstract The management of post‐traumatic osteoarthritis is fundamentally hampered by a reactive paradigm, where treatment is initiated only after irreversible structural damage becomes clinically apparent. This approach overlooks the critical early molecular and cellular cascades triggered at the moment of joint injury. A strategic shift toward pre‐emptive, disease‐modifying intervention is imperative, necessitating a precise understanding of the initial postinjury timeline and the key cellular mediators driving joint degeneration. The absence of a clearly defined early therapeutic window and validated mechanistic targets remains one of the greatest barriers to effective joint preservation after anterior cruciate ligament injury. There is a preclinical report now showing that the pathological sequence leading to post‐traumatic osteoarthritis is engaged within days, not months, following traumatic joint instability. These data redefine the acute therapeutic window and position synovial macrophages and subchondral osteoclasts as primary, actionable cellular targets for early disease interception. The future of post‐traumatic osteoarthritis prevention lies in translating this detailed biological map into timed, targeted clinical strategies aimed at halting the disease process before it becomes clinically entrenched. Notably, it is essential to acknowledge that the results necessitate a more meticulous and judicious interpretation due to limitations specific to preclinical models before extensive clinical application.
Junjie Xu (Fri,) studied this question.