The ageing meniscus: Pathophysiology, epidemiology and management

The meniscus is a fibrocartilaginous structure crucial for load distribution, shock absorption and knee stability. With advancing age, its biomechanical and biochemical integrity declines through progressive cellular senescence, accumulation of advanced glycation end-products, reduced vascularity and altered collagen cross-linking. These changes predispose to structural damage most often seen as horizontal cleavage lesions-the hallmark of meniscal ageing-best understood as 'wrinkles' of the meniscus rather than true pathology. Such lesions are often asymptomatic and incidental on MRI. However, in some individuals they may cause pain or mechanical symptoms requiring targeted, conservative management. This narrative review integrates biological, epidemiological and clinical data to provide an evidence-based framework for managing the ageing meniscus. We discuss the natural history of degenerative lesions and detail practical strategies for orthopaedic clinicians, including exercise therapy, metabolic optimization, nutritional supplementation, biomechanical offloading and injection-based interventions. Surgical treatment should remain a second-line option, reserved for patients with persistent symptoms or biomechanically significant lesions.