## 4 Discussion
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 [PERSON] 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, [PERSON] 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 [PERSON] et al. [46] and [PERSON] 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, [PERSON] et al. reported a significant correlation between age and the magnitude of cartilage wear in the femorotibbial compartment. Importantly, this correlation was consistent across different compartments of the knee joint [53]. [PERSON] 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.