The menisci play a critical protective role for the knee joint through shock absorption and load distribution. Asymptomatic meniscal tears are common and are frequent incidental findings on knee MR imaging of the middle-aged or older patient. A meniscal tear can lead to knee osteoarthritis (OA), but knee OA can also lead to a spontaneous meniscal tear through breakdown and weakening of meniscal structure. A degenerative meniscal lesion in the middle-aged or older patient could suggest early stage knee OA and should be treated accordingly. Surgical resection of nonobstructive degenerate lesions may only remove evidence of the disorder while the OA and associated symptoms proceeds.