Regional and severity-specific heterogeneity in meniscal pathology: associations with clinical etiology and patient characteristics

Meniscal injuries vary by subregion, but whether etiology and lesion severity show distinct regional patterns remains unclear. This multicenter retrospective cohort study included 979 patients with meniscal pathology. Lesions were classified into six subregions and graded 0–III according to the Stoller classification; etiology was categorized as high-energy, low-energy, or degenerative. Regression analyses assessed associations with etiology, age, sex, and body mass index (BMI). After Bonferroni correction, only medial anterior horn (MAH) and medial posterior horn (MPH) lesions were associated with etiology ( P < 0.001 and P = 0.002, respectively). In unadjusted analyses, degenerative etiology was associated with both MAH and MPH lesions, but this association remained significant only for MAH after adjustment ( OR = 1.875, P = 0.007). Older age ( OR = 1.034 per year, P < 0.001), male sex ( OR = 1.548, P = 0.011), and higher BMI ( OR = 1.060 per kg/m², P = 0.019) were independently associated with MPH lesions. For MAH severity, Grade I lesions were associated with degenerative etiology and higher BMI, whereas Grade III lesions were associated with older age and male sex. These findings demonstrate regional meniscal heterogeneity, with degenerative susceptibility and mechanical loading varying by lesion location and severity.