Meniscal extrusion increases with age: Decade-specific magnetic resonance imaging reference values

To establish decade-specific magnetic resonance imaging (MRI)-based reference values for the medial meniscal extrusion index (MEI) in adults without significant structural knee pathology and to assess associations with age and sex. The hypothesis was that decade-specific MEI values would increase with age, without meaningful sex-related differences, while remaining low in knees without significant structural abnormalities on MRI.

In June 2025, knee MRI examinations from a single tertiary orthopaedic centre were retrospectively screened until 500 eligible knees were identified (100 per decade, ages 20-69; balanced by sex). Inclusion criteria were age 20-69 years, 1.5-T MRI, and no definite/moderate osteoarthritis on MRI. Exclusion criteria included root, radial or complex meniscal tears; significant focal chondral lesions; ligament injury; discoid meniscus; prior knee surgery; inflammatory disease; evident anatomical abnormalities; and marked bone marrow edema. MEI was measured on coronal images as the ratio of extruded medial meniscus to total medial meniscal width. Linear regression tested the association between age and MEI, including an age × sex interaction term. Reference values were reported per decade as mean, standard deviation (SD) and mean + 1 SD and + 2 SD. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC).

MEI was positively associated with age (β = 0.0019 per year, R ² = 0.072, p < 0.001). No significant age × sex interaction was detected. Mean MEI increased from 0.041 in the 20-29 decade to 0.122 in the 60-69 decade. The mean + 1 SD threshold approached a 20% MEI cut-off in the 50-59 decade and exceeded it in the 60-69 decade. Interobserver reliability was excellent (ICC ≈ 0.82).

MEI increased progressively with age in knees without significant structural pathology on MRI, with no meaningful sex-related differences. Decade-specific MEI reference intervals may support age-adjusted interpretation of isolated medial meniscal extrusion, particularly in older adults, while reinforcing its role as an adjunctive imaging finding.

Level III, retrospective cohort study.