The meniscus is a critical tissue in the healthy knee joint because of its shock absorption and load distribution properties. Meniscal damage is a frequent finding on MRI of the osteoarthritis (OA) knee. The damage appears as horizontal, flap, or complex tears; meniscal maceration; or destruction. Asymptomatic meniscal lesions are common incidental findings on knee MRI of the middle-aged or older person. This challenges the health professional in choosing the best treatment. A meniscal tear can lead to knee OA, but knee OA can also lead to a spontaneous meniscal tear. A degenerative meniscal lesion often suggests early-stage knee OA. Surgical resection of nonobstructive degenerate lesions may merely remove evidence of the disorder while the OA and associated symptoms proceed.