The ageing meniscus: Pathophysiology, epidemiology and management

Area of Science:

• Orthopedics
• Biomedical Engineering
• Gerontology

Background:

• The meniscus is vital for knee function, but ages via cellular senescence and biochemical changes.
• Age-related meniscal changes include horizontal cleavage lesions, often asymptomatic.
• These degenerative changes can sometimes cause knee pain and mechanical symptoms.

Purpose of the Study:

• To review the biological and clinical aspects of the aging meniscus.
• To provide an evidence-based framework for managing degenerative meniscal lesions.
• To guide clinicians on conservative and surgical treatment options.

Main Methods:

• Narrative review integrating biological, epidemiological, and clinical data.
• Analysis of the natural history of degenerative meniscal lesions.
• Discussion of management strategies for the aging meniscus.

Main Results:

• Meniscal aging involves cellular senescence, advanced glycation end-products, and altered collagen.
• Horizontal cleavage lesions are common, often incidental findings.
• Conservative management is effective for symptomatic degenerative meniscal lesions.

Conclusions:

• Degenerative meniscal lesions are a hallmark of aging, not always pathological.
• A framework for managing the aging meniscus includes exercise, metabolic optimization, and nutritional support.
• Surgery is a secondary option for persistent symptoms or significant lesions.