: This is the first study to examine age-related patterns of meniscal/chondral lesions in women undergoing first-time knee arthroscopy. : We analyzed meniscal tear type/location and evaluated cartilage damage in femoral condyles and the tibial plateau in a medium-sized Romanian cohort ( = 241). : Age was associated significantly ( ≤ 0.004) with medial meniscal damage (O.R. = 1.04, 95% CI: 1.01-1.06), medial femoral condyle chondropathy (O.R. = 1.06, 95% CI: 1.03-1.10), and medial tibial plateau chondropathy (O.R. = 1.07, 95% CI: 1.02-1.12). Medial meniscus tear patterns differed significantly between age groups ( < 0.001, Cramér's V = 0.32). Bucket-handle tears-the most common tear type-peaked in middle age ( < 0.001, Cramér's V = 0.30). The two menisci showed different distributions of tear patterns in women aged ≥40 years ( ≤ 0.023, Cramér's V ≤ 0.41). Meniscal tears most commonly involved the posterior third. The distribution of tear sites in menisci (medial vs. lateral) varied significantly in women aged 40-59 years ( = 0.020, Cramér's V = 0.28). The medial femoral condyle and medial tibial plateau showed significant intergroup differences in ICRS scores ( ≤ 0.024, Cramér's V ≤ 0.34). The frequency of ICRS grade 4 cartilage lesions increased markedly in the 40-59 age group at both sites, continuing to rise in older patients for the medial tibial plateau. : Knee pathology in women worsens with age, especially in the medial compartment. Early screening (intervention) in middle-aged women may help prevent advanced joint damage.