An abnormal distribution of residual or reconverted red bone marrow (RBM) has been identified on routine knee MRI. We aimed to identify the prevalence and the association between RBM and symptoms and structural abnormalities in a young population (n=327, aged 31-41 years). The presence of RBM in the distal femoral, proximal tibial and fibular metaphysis was graded based on the percentage of the metaphysis occupied (grade 0 to 3). Reconverted or residual RBM around the knee joint was present only among females and always involved the distal femoral region. RBM was associated with overweight measures and knee joint pain.