The ageing meniscus is increasingly recognized as a key component of the broader process of joint senescence. While degenerative meniscal lesions are highly prevalent in middle-aged and older adults, their biological significance and optimal management remain subjects of ongoing debate.In this review, we examine the pathophysiological mechanisms underlying meniscal ageing and discuss the epidemiology, natural history, and clinical implications of degenerative meniscal lesions. Particular attention is given to horizontal cleavage lesions, which may be better understood as structural manifestations of ageing rather than true injuries. Drawing on current evidence, we propose a contemporary management framework that emphasizes meniscal preservation, patient education, exercise therapy, metabolic optimization, and selected injection-based treatments, while reserving surgery for carefully chosen cases.

By integrating biological, epidemiological, and clinical perspectives, this review seeks to contribute to an evolving paradigm that views degenerative meniscal lesions not as isolated structural defects, but as part of the broader continuum of joint ageing.