Meniscal Degeneration Patterns in Mild-to-moderate Knee Osteoarthritis in Indian Population: A Magnetic Resonance Imaging-based Analysis of Severity Correlations and Posterior Horn Predilection

Context: Knee osteoarthritis (OA) is a leading global cause of morbidity, disproportionately affecting aging populations. While radiography captures bony changes, magnetic resonance imaging (MRI) reveals soft-tissue pathologies like meniscal degeneration, which precede structural joint damage. Limited data exist on MRI-detected meniscal lesion patterns in early OA. Aims: The aim of this study was to investigate the prevalence, topographic distribution, and morphological characteristics of degenerative meniscal pathology in mild-to-moderate knee OA (Kellgren–Lawrence [KL] grades 1–3), correlating these findings with OA severity in the Indian population. Setting and Design: This cross-sectional, observational study was conducted at a tertiary center in Belagavi, India, including 92 adults with radiographically confirmed KL grade 0–3 tibiofemoral OA, following strict selection criteria. Materials and Methods: Participants underwent 1.5-Tesla MRI using proton-density–weighted and T1-weighted sequences. Meniscal pathologies were classified by location (anterior, body, and posterior) and morphology (horizontal, radial, and vertical). Two blinded assessors evaluated images (good inter-observer reliability [κ =0.72]). Statistical Analysis: Chi-square tests assessed OA grade-meniscal pathology associations, with analysis of variance for continuous variables. Analyses adjusted for age, sex, and body mass index ( P < 0.05). Results: The mean age of the cohort was 53.1 ± 5.5 years. Medial meniscal pathologies predominated (51.09%), primarily involving the posterior horn (52.17%), with horizontal tears most frequent (38.46%). Grade 2 OA accounted for 61.54% of cases, showing a significant association with medial meniscal pathology (χ 2 =24.7, P = 0.003). Conclusion: Degenerative meniscal pathology in mild-to-moderate OA disproportionately affects the medial posterior horn, with tear prevalence escalating alongside OA severity, showing direct correlation with joint deterioration, emphasizing early MRI detection in at-risk populations.