## 4 Discussion
demonstrated that high knee chondropathy is associated with increased meniscal vascularity, extending into the inner meniscal zone [28]. While the Bonar score system was initially developed for the assessment of patellar tendinopathy [23], and it primarily applies to tendons, [PERSON] et al. introduced the use of the Bonar score in meniscus root pathology in knees with osteoarthritis. They identified similarities between the fibrous connective tissue of meniscus roots and tendons in terms of microstructure [24]. In this study, we illustrated how the histopathological similarity between tendons tissue and meniscal connective tissue can be leveraged in the adapted Bonar assessment system in order to quantify meniscus conditions. Local meniscal cells, referred to as fibrochondrocytes, are a combination of fibroblasts and chondrocytes [41]. In the more superficial layer, these cells are fusiform or spindle-shaped, resembling fibroblasts, while ovoid cells more akin to chondrocytes are found deeper within the meniscus [5; 6]. [PERSON] et al. noted that an increase in cell size is a characteristic feature of senescent cells and is observed in aged menisci [42]. In our study, using the adapted Bonar score, we observed a positive correlation between age and chondrocyte morphology. The highest scores [29] indicated a predominance of increased size and round cells, as well as the presence of cell clusters. We also observed a correlation between chondrocyte morphology and gender, with men scoring higher than women for altered chondrocyte morphology. Furthermore, in addition to older age, male gender was associated with strong evidence indicating a risk factor for meniscus degeneration [43; 44; 45]. [PERSON] et al. suggested that meniscus tears become more common with increasing age. Moreover, men had a higher prevalence of meniscal tears across all age groups [46]. In our study, there was no statistically significant correlation between the adapted Bonar score and the lateral/medial meniscus, nor was there one between the modified Bonar score and the lateral/medial meniscus, either when considering all knees or dividing them into valgus and varus knees. Generally, the medial meniscus is more frequently affected by the degeneration process [46; 47; 48; 49; 50]. The reasons for this difference in our study may stem from the fact that healthy menisci are rare in knees with pathological changes. Moreover, meniscus tears are typically found in knees with osteoarthritis [17; 19]. The debate continues as to whether meniscus pathology or osteoarthritis develops first [19]. Meniscus tears can lead to articular cartilage degeneration, increasing the risk of osteoarthritis development [12]. [PERSON] et al. suggested that the discovery of a degenerative meniscal tear could be considered an early indicator of osteoarthritis [51]. In these types of tears, osteoarthritis-related changes usually occur without significant injury [19]. However, in our study, meniscus degeneration was evident in both the medial and lateral meniscus. This could result from the fact that our population comprised 44 elderly patients with chronic knee conditions, including osteoarthritis and axial knee deformities. [PERSON] et al. also found that tears were frequently observed in both medial and lateral menisci in osteoarthritis joints [18]. [PERSON] et al. demonstrated a significant increase in biomechanical parameters (vis-coelastic properties) of both menisci with the progression of joint degeneration, indicating advancing osteoarthritis degeneration. Despite differences in the pathologically affected zones and the stage of degeneration, their study revealed that both menisci are simultaneously impacted by osteoarthritis [52]. On the other hand, [PERSON] et al. established a connection between meniscus damage and finger joint osteoarthritis, one which often coexists with knee osteoarthritis.