Abstarct: Background and Objective: Anterior cruciate ligament reconstruction (ACLR) restores knee stability but fails to prevent post-traumatic osteoarthritis (PTOA). Emerging evidence suggests that inter-limb functional asymmetry may contribute to early joint degeneration. However, limited data exist in Middle Eastern athletic populations. This study aimed to investigate the relationship between early knee osteoarthritis symptoms and functional asymmetry during four single-leg hop tests in Iraqi athletes following ACLR. Methods: In this descxriptive-correlational (cross-sectional) study, 64 Iraqi athletes (aged 18–40 years) who were 7–12 months post-unilateral ACLR participated. Early osteoarthritis symptoms were classified using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Luyten criteria. Functional asymmetry was quantified via the Limb Symmetry Index (LSI) across four hop tests: single hop, triple hop, crossover hop, and 6-meter timed hop. Data were analyzed using independent t-tests and binary logistic regression. Results: Athletes with early osteoarthritis symptoms demonstrated significantly lower LSI values in all four hop tests (p ≤ 0.002, Cohen’s d = 0.86–1.02). Univariate logistic regression revealed that each 1% increase in LSI was associated with a 13–16% reduction in the odds of exhibiting osteoarthritis symptoms (OR = 0.84–0.87, p ≤ 0.007). These associations remained statistically significant after adjusting for age, sex, pre-injury Tegner activity level, graft type, and time since surgery. Conclusion: Field-baxsed hop tests serve as valid, rapid, and cost-effective screening tools for identifying Iraqi athletes at risk of early PTOA. Routine monitoring of LSI and the integration of symmetry-targeted rehabilitation protocols are recommended as effective secondary prevention strategies to mitigate long-term joint degeneration in resource-limited clinical settings.