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Article

First-Time Meniscal Surgeries Reveal Age-Linked Rise in Medial Tears and Sex-Based Injury Difference

by
Sorin Florescu
1,
Daliana Minda
2,3,* and
Cosmin Grațian Damian
4
1
Discipline of Orthopedics-Traumatology, Department XV, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Piața Eftimie Murgu 2, 300041 Timișoara, Romania
2
Research and Processing Center for Medical and Aromatic Plants (Plant-Med), “Victor Babeş” University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
3
Department of Pharmacognosy, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania
4
Faculty of Medicine, “Vasile Goldiș” Western University of Arad, Bulevardul Revoluției 94, 310025 Arad, Romania
*
Author to whom correspondence should be addressed.
Appl. Sci. 2025, 15(9), 5095; https://doi.org/10.3390/app15095095
Submission received: 12 March 2025 / Revised: 17 April 2025 / Accepted: 27 April 2025 / Published: 3 May 2025
Versions Notes

Abstract

:
Background and Objectives: Although gender and age are high-profile risk factors for meniscal injuries, their interplay is not yet fully understood. Little information is available about patients undergoing first-time meniscus surgery and the epidemiology of meniscus tears in Eastern Europe. This study investigated sex- and age-related trends in meniscal injuries (medial and/or lateral, with or without co-occurring knee chondropathy) in a substantial cohort of patients undergoing first-time meniscus surgery at a high-volume medical center in western Romania. Materials and Methods: This retrospective study included 488 patients of different ages. Logistic regression was applied across the age continuum, followed by analyses stratified by age quartiles to investigate age-related variations. Results: Increasing age was significantly associated with increased odds of having medial meniscus tears (O.R. = 1.04 (1.01–1.07)) and associated knee chondropathy (O.R. = 1.03 (1.00–1.05)). Women displayed significant, twofold lower odds of having lateral meniscus damage (O.R. = 0.54 (0.31–0.96)). Men tended to have a higher prevalence of associated knee chondropathy (O.R. = 1.71 (0.96–3.04)). The frequency of medial meniscus tears and patellar damage rose significantly, starting from the third age quartile (33–42 years) and the second quartile (23–32 years), respectively. Significant positive associations between medial and lateral meniscal damage were found across all age quartiles (rs ≥ 0.42), with their magnitude increasing with age. Medial damage also correlated significantly with patellar damage, but weaker and only from the third quartile onward (rs ≥ 0.30). Conclusions: Increasing age was linked to a higher risk of medial meniscal injuries and knee chondropathy, with the latter tending to occur earlier. Male sex was associated with a higher likelihood of lateral meniscal damage. These findings highlight the importance of considering age and sex in the diagnosis and management of meniscal injuries and provide valuable data for an Eastern European population.

1. Introduction

The menisci are crescent-shaped fibrocartilaginous structures in the knee joint that play a key role in load distribution; protection of articular cartilage; proprioception; and joint stability, lubrication, and nutrition [1,2,3]. The C-shaped medial meniscus is less mobile, being primarily involved in shock absorption and load distribution. Its structural constraints predispose it to a higher incidence of tearing, particularly during twisting or rotational movements [4]. The more circular and uniformly thick lateral meniscus is more mobile, contributing less to stability but more to joint congruity during movement [5]. The two menisci, hence, exhibit different injury patterns. The more common medial meniscus tears are often associated with degenerative changes or trauma. The less common lateral meniscus tears occur more frequently in younger, active individuals or as part of more complex injuries such as anterior cruciate ligament tears [6].
Meniscal injuries—mainly known as meniscus tears—are the most frequent type of intra-articular knee trauma in adults, reaching a prevalence of 12–14% and an average annual incidence of 60–70 cases per 100,000 individuals [7,8,9,10]. Restoring the normal anatomy of the menisci post-injury is essential for preserving proper knee biomechanics [8,9]. In fact, meniscus-deficient knees display a higher likelihood of developing osteoarthritis [11,12,13]. Notably, the etiological and pathophysiological factors behind meniscal tears differ significantly across age groups [12]. For example, younger adults under 30 years are more prone to trauma-related meniscus tears, whereas degenerative tears are more common in older patients [14]. The prevalence of lateral meniscus tears declines with age, being more common in patients younger than 20 years; the inverse pattern is observed for medial meniscal tears [6]. It is also known that meniscal tears are more common in men than women, with a male-to-female ratio between 2.5:1 and 4:1 [6,15]. Moreover, other determinants, including physical activity, socioeconomic status, occupation, and clinical factors (e.g., obesity, joint alignment abnormalities, previous meniscal injuries) can influence both the incidence and specific presentation of meniscal lesions [7,16].
In addition to meniscal injuries, knee chondropathy is often observed in conjunction with meniscus tears. This term is used here to define a disease, damage, or degeneration of the articular cartilage covering the bone ends in joints (femur, tibia, patella) [17]. This pathology can compromise the structural integrity of the knee joint, leading to accelerated degenerative changes [17,18]. The coexistence of knee chondropathy and meniscal rupture (tears) could, hence, exacerbate clinical outcomes by further contributing to joint instability and hindering the healing capacity of the affected tissues. Moreover, inflammation affecting both the synovium and meniscus contribute to knee pain and functional symptoms in patients with meniscal tears. This interaction plays a clinically relevant role, as targeting inflammation within the synovial membrane and meniscal tissue may help alleviate preoperative symptoms and improve functional outcomes [19].
In this context, the meniscus has been a field of extensive research over the past decades. Research has covered a wide spectrum of topics—from prevention and prevalence to injury mechanisms and treatment—with thousands of articles published in recent years [20,21]. However, several knowledge gaps still persist. First, the interplay between age, sex, and meniscal tears is yet to be fully understood [20,21]. Second, little information is available about the prevalence of different types of meniscal lesions in subjects undergoing first-time meniscal surgery [9,12,22]. These patients provide an unaltered perspective of meniscal pathologies, enabling more precise determination of the types, locations, and severity of tears before surgical intervention or postoperative changes affect the tissue. This cohort also sheds light on risk factors and predictors of outcomes, which may guide preventive measures [23]. Third, research to date was either conducted on the entire age continuum or focused on specific age brackets rather than combining these methodologies. This approach enables scientists to achieve a more robust and detailed understanding of age-related changes and the influencing factors. Finally, less knowledge regarding meniscus tears is available for Eastern Europe than for Western Europe due to differences in healthcare infrastructure, research funding and prioritization, resource availability, and socioeconomic factors [21,24,25]. This study aimed to determine the influence of age and sex on the distribution of medial and lateral meniscal tears and their association with chondropathy in a large cohort of Romanian patients undergoing first-time meniscal surgery. We adopted a potent statistical methodology that incorporates logistic regression followed by age quartile-specific analysis. The present findings will contribute to a better understanding of the age- and sex-related trends in meniscal tears, particularly in Eastern Europe, ultimately contributing to better diagnosis, treatment, and future research in this field.

2. Materials and Methods

2.1. Study Population

A retrospective study, approved by the Institutional Ethics Committee of Arad County Emergency Clinical Hospital (approval number 92/20.01.20252), was conducted to determine age- and sex-related patterns in meniscal tears in patients undergoing first-time meniscal surgery. This investigation was performed in compliance with the principles outlined in the Declaration of Helsinki. Medical records of patients who visited the hospital between August 2015 and January 2025 for knee discomfort were reviewed to identify those who underwent their first surgical procedure for a meniscal injury. The study population included patients across the entire age continuum, irrespective of sex. The primary inclusion criteria were as follows: (i) first-time arthroscopic intervention for symptomatic meniscal tears confirmed via clinical evaluation and magnetic resonance imaging (MRI); (ii) intraoperative arthroscopic confirmation of meniscus tears (lateral, medial, or both, with or without chondropathy); (iii) availability of complete clinical and demographic data for all variables of interest—specifically, age, sex, diagnosis, and meniscal tear type; and (iv) documented failure of conservative treatment, primarily > 4–6 weeks of physical therapy and/or non-steroidal anti-inflammatory drugs.
Exclusion criteria included (i) previous surgery on the affected knee, including arthroscopy, ligament reconstruction, or cartilage repair; (ii) concomitant ligament injuries such as anterior cruciate ligament, posterior cruciate ligament, or collateral ligament tears, confirmed via MRI or intraoperative findings; (iii) presence of systemic inflammatory conditions affecting joint health (e.g., rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis); (iv) neurological or musculoskeletal conditions affecting gait, joint stability, or loading (e.g., multiple sclerosis, Parkinson’s disease, cerebral palsy); (v) history of significant acute trauma to the affected knee (e.g., high-energy fractures, dislocations, or blunt force trauma) unrelated to isolated meniscal tears; (vi) cases with uncontrolled chronic diseases (e.g., diabetes, cardiovascular diseases); and (vii) incomplete or inconsistent clinical documentation, including missing or unclear preoperative imaging, surgical reports, or demographic information essential for eligibility verification and statistical modeling. All patients provided informed consent in accordance with ethical guidelines.

2.2. Statistical Analysis

A parsimonious approach was applied to maintain statistical power and avoid overfitting, prioritizing age and sex as presurgical predictors in our logistic regression models. This decision intentionally excluded other potentially relevant factors, such as activity level, weight, body mass index (BMI), and comorbidities, thus restricting the number of model variables [26]. This strategy ensured the findings are easily interpretable and applicable in diverse clinical settings, given the universal availability and clinical significance of age and sex [27].
Logistic regression was used to quantify the effect of age and sex on the frequency of medial meniscal damage, lateral meniscal damage, and associated knee chondropathy. Dependent variables (outcomes) were coded as 1 for presence and 0 for absence. Sex was binary-coded, with men as the reference group (0) and women (1) compared against this baseline. Age was included as a continuous predictor in this regression and was not categorized. The direction and strength of association between significant predictor variables and outcomes were assessed using odds ratios.
The medical literature supports the existence of a non-linear relationship between age and knee joint lesions [28,29,30]. We therefore performed stratified analysis based on age quartiles to reveal potential age-dependent patterns in these outcomes. This approach allowed us to identify potential non-linear relationships between age and outcomes while avoiding the Simpson’s paradox—a statistical phenomenon where a trend appears in different groups of data but disappears or reverses when the groups are combined [31]. We chose to use four age quartiles of similar size to optimally balance statistical power, granularity, and interpretability. This reduced the potential risk of bias that might arise from underrepresented age groups while controlling for age as a confounder and addressing non-linearity. Differences in the frequencies of individuals with and without meniscal damage/chondropathy were analyzed using Chi-square tests with 4 × 2 contingency tables. For significant outcomes, paired comparisons using Chi-square tests (with Bonferroni correction) based on 2 × 2 contingency tables against the lowest quartile were run as post hoc testing [32]. Each comparison was performed against the lowest age quartile (Q1) as the reference group. Finally, phi coefficients were used to measure the strength of association between medial meniscal damage, lateral meniscal damage, and associated knee chondropathy across different age quartiles. The phi coefficients are recommended to be used for measuring associations between two binary variables [33]. A p value less than 0.05 was considered significant. Data analysis was conducted using the Statistica 10 software (StatSoft Inc., Tulsa, OK, USA).

3. Results

Table 1 shows the results of logistic regression for outcomes analyzed, with sex and age serving as predictor variables (factors). Age was a significant factor affecting the prevalence of medial meniscal damage, with each additional year increasing the odds by 4%. In contrast, it had no effect on predicting lateral meniscal damage. However, age emerged as a significant predictor influencing the likelihood of having chondropathy of the knee. The magnitude of its effect was comparable to that seen in medial meniscal damage.
Sex did not influence the prevalence of medial meniscal damage. However, it had a significant effect on the probability of having lateral meniscal damage, with women showing a 46% reduction in odds compared with men. However, women exhibited a borderline trend for higher odds of having knee chondropathy associated with meniscus rupture. The age × sex interaction was not significant irrespective of outcome, supporting that the relationship between age and different outcomes is consistent across the sexes.
The age range, number of individuals, and sex distribution corresponding to each age quartile are shown in Table 2. Sex distribution was similar among different age quartiles (Chi-square test, p = 0.293). The distribution of patients with and without injuries of the knee joint across age quartiles is presented in Table 3. We found significant inter-strata differences in the prevalence of medial meniscal damage and knee chondropathy. In contrast, no differences were observed for lateral meniscus.
Among the analyzed outcomes, only the prevalence of medial meniscal damage showed a clear age-dependent increase. The measured values in the second, third, and fourth quartiles were significantly above those seen in the first quartile. Aside from age being a non-significant predictor for lateral meniscal rupture (see Table 1), the prevalence of this pathology showed very small variations across the different age quartiles. However, the frequency of knee chondropathy tended to increase with age. It showed a sharp increase in the second age quartile, followed by a much slower rise after this quartile. The frequency of this condition in the lower quartile was significantly below those measured in the other quartiles.
The correlations between the outcomes analyzed in this study are shown in Table 4. The prevalence of medial meniscal damage correlated significantly with the occurrence of lateral meniscal damage across all age quartiles. The strength of these relationships increased with age. The former variable was also positively associated with the frequency of knee chondropathy, but only from the second age quartile onward. The magnitude of these correlations was relatively weaker compared with that noted between those previously mentioned, remaining constant across the upper three quartiles. In contrast, no significant correlations were observed between lateral meniscal damage and any patellar damage.

4. Discussion

The current investigation identified age as a significant predictor of the risk for medial meniscal tears but not for lateral meniscal tears. This finding aligns with the existing orthopedic literature [6,28,34]. For example, Ralles et al. found that longer time to surgery was associated with a higher prevalence of medial meniscal damage in 1434 patients undergoing anterior cruciate ligament (ACL) reconstruction—suggesting that both age and surgical delay contribute to degenerative progression. In contrast, no relationship was found for lateral meniscus tears [34]. Tandogan et al. reported comparable outcomes for 764 patients undergoing first-time arthroscopic treatment for ACL tears [28]. Similarly, Ridley et al. revealed an age-dependent increase in the prevalence of isolated medial meniscus tears within a cohort of 782 individuals [6]. Greater age-related degeneration in the medial meniscus [35] may be explained by its distinct biomechanical and anatomical properties. The medial meniscus is subjected to greater compressive and shear forces during weight-bearing activities (e.g., walking, running, jogging, hiking, dancing, stair climbing, tennis, basketball, squats, lunges) because of its connection to the medial collateral ligament and its less mobile nature compared with the lateral meniscus [35,36,37].
Despite an obvious trend of age-dependent increase in the prevalence of medial meniscal tears, a significant rise was observed only from the third age quartile onward, corresponding to individuals aged 33 years and older. Indeed, a recent study reported that meniscal tears are more common than previously identified, particularly in patients over 30 years old [38]. In a study of surgically treated patients, isolated medial meniscal tears were also more common in individuals over 30 years of age, with 52.2% of such tears occurring in this age group [6]. In addition, meniscal tears significant enough to warrant treatment are 2–3 times more frequent after the fourth decade of life [39]. Moreover, the prevalence of medial meniscal injuries increases with age, reaching 50% in adults over 70 years old, suggesting a degenerative etiology [40]. These observations are consistent with the timeframe during which the frequency of medial meniscus injuries begins to rise in our study. Most probably, these data reflect the combined effect of cumulative mechanical stress and biological aging processes. Age-related changes in the meniscus, e.g., cellular senescence, reduced proteoglycan content, decreased collagen cross-linking, and the accumulation of advanced glycation end products, contribute to meniscus stiffness and vulnerability, making it more susceptible to damage [41].
No significant association was found between age and lateral meniscal rupture, with quartile-based analysis revealing no meaningful differences across the age groups. Lateral meniscal injuries may, hence, be more strongly related to acute trauma, such as sports injuries or high-impact activities, rather than gradual degeneration. This may be related to the anatomical position and greater mobility of the lateral meniscus, which reduce its exposure to chronic stress but increase its vulnerability to rapid rotational movements or valgus forces [42]. In fact, Krych et al. reported that lateral meniscal injuries are disproportionately higher in younger, active populations involved in pivot-heavy sports, such as soccer or basketball, where acute traumas are more common [43].
Men had an almost twofold higher risk for lateral meniscus injuries, but no sex differences were observed for the prevalence of medial meniscus injuries. Similar trends have rarely been described, particularly in the context of adult cohorts. To the best of our knowledge, only Chhadia et al. reported a decrease in the risk of lateral meniscus injury in adult women versus men, but this study included patients with previous meniscus repair surgery [44]. Additional evidence for sex-specific differences in meniscus injury patterns derives from pediatric populations, with many studies being conducted in the context of anterior cruciate ligament (ACL) injuries [45,46,47]. It was found that men are typically prone to lateral meniscal tears, while women display a higher prevalence of medial meniscal injuries. For example, Jackson et al. investigated injury patterns in 880 pediatric patients. Male patients experienced lateral meniscal tears in 74% of cases; in comparison, female patients experienced them in 65% of cases. Women had medial tears in 24% of cases; this contrasts with 17% in men [45]. Similar gender differences were reported more recently by Rohde et al. [46] and Pruneski et al. [47]. Other studies, however, found no effect of gender on meniscal injury rates in younger cohorts, supporting that this relationship may not be as straightforward in pediatric populations [48].
While age and sex differences in medial and lateral meniscal tear patterns are well recognized, these findings should be interpreted within the broader context of knee joint pathology. Several other factors, such as BMI or concomitant injuries, strongly affect the prevalence and prognosis of meniscal tears. Specifically, elevated BMI is associated with a high risk of meniscal (re)injury, and it complicates recovery due to increasing stress on the knee joint [49]. Concomitant injuries (e.g., ligament damage or cartilage defects) can exacerbate symptoms and hinder the effectiveness of treatment [50]. Sex differences in meniscal injury patterns may also derive from anatomical and biomechanical differences. As an example, a steeper lateral posterior tibial slope and an elevated femoral notch width are risk factors for lateral meniscal injuries in men. A steeper lateral posterior tibial slope and a lowered intercondylar notch depth, on the other hand, are risk factors in women [51]. It was also found that men typically have larger and differently shaped menisci; this, in turn, may predispose them to specific types of injuries [52].
A considerable proportion of patients presented with concomitant meniscal rupture and knee chondropathy, with age emerging as a significant predictor of this combined pathology. Medical evidence supports this connection. Thus, Sieron et al. reported a significant correlation between age and the magnitude of cartilage wear in the femorotibial compartment. Importantly, this correlation was consistent across different compartments of the knee joint [53]. Krieger et al. also found a higher prevalence of advanced patellar chondropathy in individuals in their fifth decade and older [54]. It is likely that additive factors (e.g., cartilage degeneration, altered joint biomechanics, previous injuries, impaired healing capacity) contribute to this trend of elevated prevalence of meniscus tears and knee chondropathy with age. First, the aging cartilage starts to thin and develop fissures due to alterations in proteoglycan content and collagen matrix organization [41,55]. Second, reduced muscle strength and joint stability alter knee biomechanics, increasing joint stress and accelerating cartilage wear, particularly in individuals with prior knee injuries [56]. Third, the age-related decline in blood supply to the cartilage impairs the repair processes post-injury, contributing to chondropathy progression [57].
The frequency of concurrent meniscal tears/rupture and knee chondropathy rose very steeply at the start of the third decade of life (around 23 years). Such information has not been yet reported. Interestingly, this timeframe typically overlaps with the transition from adolescence to early adulthood [58], when the maturation of the knee joint completes. This transition reflects a decline in regenerative capacity, marking a shift from a phase of active tissue repair to one characterized by slower and less-efficient healing. The knee joint thus becomes more vulnerable to the additive effects of mechanical stress, injury, and cartilage degeneration [59].
Knee cartilage and menisci, though both vital for joint function, have distinct structures, roles, and healing capacities. The translucent cartilage on the femur, tibia, and patella is a hyaline cartilage composed of scattered chondrocytes and primarily type II collagen aimed at reducing friction and shock absorption. This avascular articular cartilage has a limited self-healing potential; hence, symptomatic cases often necessitate surgical treatment [60]. In contrast, the menisci include chondrocytes arranged in rows and mainly type I collagen, with greater structural strength and mechanical resistance than type II collagen. These fibrocartilages have a limited but better healing capacity, especially at the outer edge, where the blood supply is more readily available [61]. These inherent differences in structure, composition, and healing potential likely contribute to the distinct patterns of age-related degeneration observed here between the articular cartilage and the menisci.
The link between sex and chondropathy of the knee joints has rarely been studied as a specific topic in orthopedic research. Here, we identified a borderline significant trend for higher odds of knee chondropathy in female patients. There is, in fact, relevant—though largely indirect—evidence that supports our findings, as most existing studies examine sex-based differences in the prevalence or incidence of knee osteoarthritis, a condition widely regarded as a progression of knee chondropathy. It was found that women tend to have higher odds for this condition due to a combination of several factors, such as anatomical differences (e.g., narrower femurs, larger quadriceps angles, less cartilage volume), medical variables (e.g., higher vulnerability to knee re-injury), and hormonal determinants (e.g., decline in estrogen in postmenopausal women) [62,63,64].
Meniscal tears are often considered a precursor to the development of knee chondropathy. These lesions increase stress on knee articular cartilage, exacerbating existing damage and increasing the risk of chondral injuries [65,66]. On the other hand, chondropathy could precede meniscal tears. Cartilage wear may over time cause meniscal degeneration, increasing the risk of rupture or tears due to compromised integrity of the meniscal structure. Irrespective of the origin of this (most probably) bidirectional relationship, it is well established that the presence of meniscal tears often correlates with the severity of cartilage injuries [65]. Notably, knee traumatisms are associated with elevated matrix metalloproteinase (MMP) and prostaglandin E2 (PGE2) levels in synovial fluid [66]. These compounds are potent mediators of cartilage inflammation and degradation, and as a result, they may drive further damage, accelerating osteoarthritis development and progression [66].
The lack of significant age–sex interaction in the outcomes analyzed renders age as a dominant factor irrespective of sex. The age-dependent increase in the strength of correlations between medial and lateral meniscal tears suggests that the likelihood of these injuries increases as individuals grow older. It is plausible that this trend is related to the progression of degenerative joint diseases such as osteoarthritis, where damage spreads due to cumulative wear and tear [14,59]. On the other hand, weaker correlations with meniscal damage across all quartiles suggest meniscal injuries are generally distinct, with a modest age-related association
The design and scope of this research provides valuable insights into meniscal injuries and associated knee chondropathies. First, the exclusive focus on first-time meniscal surgery enables a more accurate epidemiological and anatomical characterization of injury patterns before any surgical or postoperative changes alter tissue integrity. This, in turn, allows a clearer interpretation of natural disease progression. Second, the use of age quartiles uncovers trends that could be masked by analyzing the age continuum or isolated age groups. This approach delivers a refined understanding of the non-linear relationship between age and meniscal injuries. Third, the focus on age and sex as predictors increases the generalizability and clinical utility of the findings, especially in settings with inconsistent data on BMI, physical activity, or comorbidities. Finally, these findings help bridge the geographic and demographic gaps in the orthopedic literature by including a large cohort from an underrepresented Eastern European population.
This study offers practical insights that can directly inform clinical decision making and patient management strategies. Age-dependent increases in meniscus tears encourages earlier imaging and preventive strategies in aging populations. The marked rise of chondropathy in young adulthood emphasizes the need for early detection/intervention in young adults to prevent progression. The strength of the correlation between medial meniscal tears and chondropathy increased with age. This trend favors the inclusion of cartilage status in preoperative assessments for meniscal surgery. Moreover, these findings support sex-specific risk assessment and treatment planning, as lateral meniscal tears were more prevalent in men and did not show an association with age.
Despite its strengths, this study—like all observational research—has several limitations that should be acknowledged. One can argue that a major limitation of this study is the focus on age and sex. These variables are often the strongest, most universal, and clinically relevant predictors for injury patterns and disease progression in orthopedic research [6,12,14,15]. However, other factors—especially BMI and physical activity—play key roles in knee joint biomechanics and injury risk [4,5,8,11,14,31]. The intentional decision to exclude these parameters from regression models was based on our aim to focus on universally available clinical variables—age and sex—that are easily accessible in all healthcare settings [1,3,35]. Since BMI and physical activity levels were not consistently documented across the medical records, their inclusion would also have introduced significant data heterogeneity and risk of selection bias. Moreover, the simplicity of this approach enhances the clinical applicability of the present findings while avoiding overfitting and statistical noise. Nevertheless, we acknowledge the exclusion of these factors as a drawback and encourage future prospective studies to explore the interactive role of lifestyle and metabolic factors in meniscal pathology.
Since this study was run at a single-center facility in Eastern Europe, it is not representative of different healthcare frameworks, surgical methods, or patient populations. While the sample is region-specific, the methodology applied is robust and can be extrapolated to other international studies to assess broader applicability. The present investigation also analyzes only patients having first-time meniscal surgeries without determining long-term outcomes, re-injury rates, or progression to osteoarthritis. Nonetheless, this focus on unaltered pathology reflects natural injury progression without the bias introduced by prior surgical interventions. Moreover, it lays the groundwork for future longitudinal studies, identifying key trends that warrant long-term monitoring.
Finally, we excluded patients with ligament injuries (e.g., anterior cruciate ligament, posterior cruciate ligament) and other knee conditions (e.g., chondromalacia, arthritis). Indeed, this approach limits our ability to understand how meniscal injuries interact with other joint pathologies, which is common in real-world clinical settings. On the other hand, the exclusion of confounding injuries enabled a more precise analysis of meniscal damage without interference from co-existing knee pathologies. Including multiple injury types could skew the data, making it harder to identify specific trends related to meniscal damage alone.

5. Conclusions

This study provides new insights into the age- and sex-related epidemiology of meniscal injuries among patients undergoing first-time meniscus surgery in Eastern Europe. Our findings reveal that increasing age is significantly associated with a higher prevalence of medial meniscal damage and knee chondropathy, with knee chondropathy occurring earlier than medial meniscal injuries. In contrast, lateral meniscal damage did not exhibit a significant age-related trend, suggesting different etiological pathways for medial versus lateral meniscus tears. Male patients were more likely to experience lateral meniscal damage, whereas female patients showed a borderline increased tendency toward knee chondropathy. The stratified age quartile analysis confirmed a significant age-dependent increase in medial meniscal damage, particularly from the third quartile (33 years and older) onward. Similarly, knee chondropathy exhibited a sharp rise starting from the second quartile (23–32 years), reinforcing the hypothesis that cartilage degeneration precedes or accompanies meniscal injuries over time. The strong associations between medial and lateral meniscal damage across all age groups, which intensified with advancing age, indicate that joint degeneration may lead to multi-structural knee damage. Our findings emphasize the importance of considering both age and sex in the diagnosis, management, and prevention of meniscal injuries. The observed patterns have direct clinical implications, particularly for surgical decision making and rehabilitation strategies tailored to patient demographics. Given that this study was conducted in a previously understudied Eastern European population, our results contribute valuable epidemiological data, helping to bridge regional gaps in orthopedic research.

Author Contributions

Conceptualization: C.G.D.; methodology: C.G.D.; software: D.M.; validation: C.G.D.; formal analysis: C.G.D.; investigation: C.G.D.; resources: S.F.; data curation: D.M.; writing—original draft preparation: C.G.D.; writing—review and editing: D.M. and S.F.; visualization: D.M.; supervision: C.G.D. and S.F.; funding acquisition: C.G.D. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee at Arad County Emergency Clinical Hospital (approval No. 92/20.01.2025). Written informed consent was obtained from all the participants.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

All the data generated or analyzed in this study are included in this published article.

Acknowledgments

We would like to acknowledge VICTOR BABES UNIVERSITY OF MEDICINE AND PHARMACY TIMISOARA for their support in covering the costs of publication for this research paper.

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. Regression results for age, sex, and age–sex interaction on outcome variables.
Table 1. Regression results for age, sex, and age–sex interaction on outcome variables.
Age
VariableO.R.p Value
MMD1.04 (1.01–1.07)<0.001 ***
LMD0.99 (0.92–1.09)0.436
KAC1.03 (1.00–1.05)0.002 **
Sex
VariableO.R.p Value
MMD1.01 (0.67–1.51)0.979
LMD0.54 (0.31–0.96)0.035 *
KAC1.71 (0.96–3.04)0.065
Age × Sex Interaction
VariableO.R.p Value
MMD1.01 (0.79–1.04)0.646
LMD0.99 (0.95–1.03)0.614
KAC1.01 (0.96–1.05)0.673
MMD, medial meniscal damage; LMD, lateral meniscal damage; KAC, knee chondropathy. Data are presented as absolute values with the corresponding percentages (in parentheses). Marked bold values (*) indicate significant outcomes (logistic regression, ***—p < 0.001, **—p < 0.01, *—p < 0.05).
Table 2. Age quartile distribution by sex and total individuals.
Table 2. Age quartile distribution by sex and total individuals.
Age Range (years)Individuals
(number)		MaleFemale
Q1 (0–25%)1–2212988 (68.22)41 (31.78)
Q2 (26–50%)23–3212793 (73.23)34 (26.77)
Q3 (51–75%)33–4211572 (62.61)43 (37.79)
Q4 (76–100%)43–7511784 (71.79)33 (28.21)
Data in the fourth and fifth columns are given as absolute values with the corresponding percentages (in parentheses).
Table 3. Prevalence of different types of knee joint injuries in age quartiles.
Table 3. Prevalence of different types of knee joint injuries in age quartiles.
QuartileWith DamageWithout Damage p Value
Medial meniscus <0.001 ***
Q130 (23.62)99 (76.74)
Q243 (33.86)84 (66.14)0.008 **
Q350 (43.48)65 (56.52)<0.001 ***
Q460 (51.28)57 (48.72)<0.001 ***
Lateral meniscus
Q122 (17.05)107 (82.95)0.761
Q225 (19.69)102 (80.31)
Q322 (18.26)94 (81.74)
Q419 (16.24)198 (83.76)
Knee chondropathy <0.001 ***
Q197 (36.43)81 (63.57)
Q2104 (81.89)23 (18.11)<0.001 ***
Q392 (84.35)18 (15.65)<0.001 ***
Q4106 (90.6)11 (9.4)<0.001 ***
Data are presented as absolute values with the corresponding percentages (in parentheses). “Without damage” refers to the absence of injury at that specific site; however, patients had lesions (sometimes multiple) in other compartments analyzed. p-values in the rightmost column represent Chi-square comparisons across all four quartiles for each injury type (overall significance) Additional p-values listed within each injury sub-table reflect post hoc Chi-square comparisons with Bonferroni correction, comparing each quartile against the reference group (Q1). Marked bold values (*) show significant differences (Chi-square tests, ***—p < 0.001, **—p < 0.01, *—p < 0.05).
Table 4. Correlations among different types of knee joint injuries in age quartiles.
Table 4. Correlations among different types of knee joint injuries in age quartiles.
VariableLMDKAD
Q1
MMD0.42 *0.21
LMD 0.18
Q2
MMD0.55 *0.38 *
LMD −0.12
Q3
MMD0.50 *0.30 *
LMD 0.25
Q4
MMD0.60 *0.40 *
LMD 0.15
MMD, medial meniscal damage; LMD, lateral meniscal damage; KAD, knee chondropathy. Marked values (*) indicate significant outcomes (Phi coefficients, ***—p < 0.001, **—p < 0.01, *—p < 0.05).
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Florescu, S.; Minda, D.; Damian, C.G. First-Time Meniscal Surgeries Reveal Age-Linked Rise in Medial Tears and Sex-Based Injury Difference. Appl. Sci. 2025, 15, 5095. https://doi.org/10.3390/app15095095

AMA Style

Florescu S, Minda D, Damian CG. First-Time Meniscal Surgeries Reveal Age-Linked Rise in Medial Tears and Sex-Based Injury Difference. Applied Sciences. 2025; 15(9):5095. https://doi.org/10.3390/app15095095

Chicago/Turabian Style

Florescu, Sorin, Daliana Minda, and Cosmin Grațian Damian. 2025. "First-Time Meniscal Surgeries Reveal Age-Linked Rise in Medial Tears and Sex-Based Injury Difference" Applied Sciences 15, no. 9: 5095. https://doi.org/10.3390/app15095095

APA Style

Florescu, S., Minda, D., & Damian, C. G. (2025). First-Time Meniscal Surgeries Reveal Age-Linked Rise in Medial Tears and Sex-Based Injury Difference. Applied Sciences, 15(9), 5095. https://doi.org/10.3390/app15095095

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