What are the main types of knee ligament injuries. How are knee ligament injuries diagnosed and treated. What are the best ways to prevent knee ligament injuries.

Understanding Knee Ligament Anatomy and Function

The knee joint relies on four main ligaments to provide stability and enable proper movement. These crucial structures connect the thighbone (femur) to the shinbone (tibia):

• Anterior cruciate ligament (ACL)
• Posterior cruciate ligament (PCL)
• Medial collateral ligament (MCL)
• Lateral collateral ligament (LCL)

Each ligament plays a specific role in knee function. The ACL, located in the center of the knee, controls rotation and forward movement of the shin bone. The PCL prevents the shin from moving too far backward. The MCL and LCL provide stability to the inner and outer knee respectively.

Common Causes of Knee Ligament Injuries

Knee ligament injuries can occur due to various factors, including:

• Trauma from accidents (e.g., car crashes)
• Sports-related injuries (e.g., sudden twisting motions)
• Falls or missteps
• Overuse and repetitive stress

Sports that involve rapid changes in direction, jumping, or physical contact pose a higher risk for knee ligament injuries. Examples include basketball, football, soccer, and skiing. Understanding these risk factors can help athletes and active individuals take appropriate precautions.

Recognizing Symptoms of Knee Ligament Injuries

Identifying the signs of a knee ligament injury is crucial for timely treatment. Common symptoms include:

• Sudden, severe pain
• Swelling within the first 24 hours
• Limited range of motion
• Instability or feeling of “giving way”
• Popping or snapping sound at the time of injury

The severity and location of these symptoms can vary depending on which ligament is affected and the extent of the damage. Prompt medical attention is essential for accurate diagnosis and appropriate treatment.

Diagnostic Procedures for Knee Ligament Injuries

Proper diagnosis of knee ligament injuries involves a combination of physical examination and imaging techniques. Healthcare providers typically use the following methods:

1. Physical examination: Assessing range of motion, stability, and pain points
2. Medical history review: Understanding the circumstances of the injury
3. Imaging tests:
   • X-rays: To rule out bone fractures
   • MRI (Magnetic Resonance Imaging): For detailed soft tissue visualization
   • Ultrasound: To assess ligament and tendon damage

These diagnostic procedures help determine the specific ligament affected and the severity of the injury, guiding treatment decisions.

Treatment Options for Knee Ligament Injuries

The treatment approach for knee ligament injuries depends on the severity of the damage and the patient’s individual needs. Options include:

Conservative Treatment

• RICE protocol (Rest, Ice, Compression, Elevation)
• Physical therapy and rehabilitation exercises
• Bracing or supportive devices
• Non-steroidal anti-inflammatory drugs (NSAIDs) for pain management

Surgical Intervention

In cases of severe ligament tears or when conservative treatments prove ineffective, surgical repair may be necessary. Common surgical procedures include:

• Arthroscopic ligament reconstruction
• Ligament repair or reattachment
• Graft procedures using autografts or allografts

Post-surgical rehabilitation is crucial for optimal recovery and return to normal activities or sports.

Rehabilitation and Recovery Process

Rehabilitation plays a vital role in recovery from knee ligament injuries, whether treated conservatively or surgically. The process typically involves:

1. Range of motion exercises
2. Strength training for surrounding muscles
3. Balance and proprioception exercises
4. Sport-specific training (for athletes)
5. Gradual return to activities

The duration of rehabilitation varies depending on the severity of the injury and the treatment approach. It can range from a few weeks for minor sprains to several months for reconstructive surgeries.

Preventing Knee Ligament Injuries

While not all knee ligament injuries can be prevented, certain measures can reduce the risk:

• Proper warm-up and cool-down routines
• Strength training for leg muscles, particularly quadriceps and hamstrings
• Improving flexibility through regular stretching
• Using proper technique in sports and physical activities
• Wearing appropriate protective gear and footwear
• Maintaining a healthy weight to reduce stress on the knees

Incorporating these preventive strategies into daily routines and athletic training can significantly lower the likelihood of knee ligament injuries.

Long-term Outlook and Potential Complications

The prognosis for knee ligament injuries varies based on several factors:

• Type and severity of the injury
• Timeliness and quality of treatment
• Patient’s age and overall health
• Adherence to rehabilitation protocols

Potential long-term complications may include:

• Chronic knee instability
• Increased risk of re-injury
• Development of osteoarthritis
• Persistent pain or limited range of motion

Regular follow-ups with healthcare providers and maintaining knee strength and flexibility can help mitigate these risks and improve long-term outcomes.

Advances in Knee Ligament Treatment and Research

The field of knee ligament treatment continues to evolve, with ongoing research and technological advancements. Some promising areas include:

• Regenerative medicine techniques (e.g., stem cell therapy, platelet-rich plasma injections)
• Improved surgical techniques and materials
• Enhanced rehabilitation protocols and technologies
• Personalized treatment approaches based on genetic and biomechanical factors

These developments aim to improve treatment outcomes, reduce recovery times, and enhance the overall quality of life for individuals with knee ligament injuries.

Living with Knee Ligament Injuries: Lifestyle Adjustments and Coping Strategies

Adapting to life with a knee ligament injury or post-treatment recovery often requires certain lifestyle modifications. Consider the following strategies:

• Modifying activities to reduce stress on the knee
• Using assistive devices when necessary (e.g., crutches, knee braces)
• Maintaining a healthy diet to support healing and manage weight
• Practicing stress-reduction techniques to cope with pain and limitations
• Joining support groups or seeking counseling for emotional support

Implementing these adjustments can help individuals maintain a high quality of life while recovering from or managing knee ligament injuries.

The Role of Physical Therapy in Knee Ligament Rehabilitation

Physical therapy is a cornerstone of knee ligament injury treatment and rehabilitation. It serves multiple purposes:

• Restoring range of motion and flexibility
• Strengthening muscles that support the knee
• Improving balance and proprioception
• Reducing pain and swelling
• Preventing re-injury through proper movement techniques

A typical physical therapy program may include:

1. Manual therapy techniques
2. Targeted exercises and stretches
3. Electrical stimulation or ultrasound therapy
4. Gait training and functional movement exercises
5. Education on proper body mechanics and injury prevention

The duration and intensity of physical therapy vary based on the individual’s needs and progress. Consistency and adherence to the prescribed program are crucial for optimal outcomes.

Nutritional Considerations for Knee Ligament Health

Proper nutrition plays a significant role in maintaining healthy knee ligaments and supporting recovery from injuries. Key nutritional factors include:

• Adequate protein intake for tissue repair and growth
• Vitamins C and E for their antioxidant properties
• Omega-3 fatty acids to reduce inflammation
• Calcium and vitamin D for bone health
• Collagen-rich foods or supplements to support ligament strength

A balanced diet that includes a variety of fruits, vegetables, lean proteins, and whole grains can provide these essential nutrients. In some cases, targeted supplements may be recommended under medical supervision.

The Impact of Age on Knee Ligament Injuries and Recovery

Age is a significant factor in both the occurrence and recovery of knee ligament injuries. Consider the following age-related aspects:

In Younger Individuals:

• Higher risk of injury due to participation in high-impact sports
• Generally faster healing and recovery times
• Greater likelihood of returning to pre-injury activity levels

In Older Adults:

• Increased risk due to age-related changes in ligament strength and elasticity
• Longer healing times and potentially more complicated recovery
• Higher risk of associated conditions like osteoarthritis

Treatment approaches and rehabilitation strategies may need to be adjusted based on the patient’s age to ensure the best possible outcomes.

Emerging Technologies in Knee Ligament Injury Diagnosis and Treatment

Advancements in medical technology continue to improve the diagnosis and treatment of knee ligament injuries. Some notable innovations include:

• 3D printing for custom knee braces and surgical guides
• Virtual reality systems for rehabilitation exercises
• Wearable sensors for monitoring recovery progress
• Artificial intelligence for analyzing imaging results and predicting outcomes
• Robotic-assisted surgery for improved precision in ligament reconstruction

These technologies aim to enhance diagnostic accuracy, improve surgical outcomes, and optimize rehabilitation processes, ultimately leading to better patient care and faster recovery times.

The Psychological Impact of Knee Ligament Injuries

The effects of knee ligament injuries extend beyond physical symptoms, often having significant psychological implications. Common psychological challenges include:

• Anxiety about re-injury or future performance
• Depression related to physical limitations and lifestyle changes
• Loss of identity, particularly for athletes
• Frustration with the recovery process
• Fear of returning to sports or activities

Addressing these psychological aspects is crucial for comprehensive care. Strategies may include:

1. Psychological counseling or sports psychology interventions
2. Setting realistic goals and expectations
3. Developing coping mechanisms and stress management techniques
4. Gradually reintroducing activities to build confidence
5. Connecting with support groups or others who have experienced similar injuries

Integrating psychological support into the treatment plan can significantly enhance overall recovery and help individuals return to their desired activities with confidence.

The Economic Impact of Knee Ligament Injuries

Knee ligament injuries can have substantial economic implications, both for individuals and healthcare systems. Consider the following aspects:

• Direct medical costs (surgery, rehabilitation, medications)
• Indirect costs (lost productivity, time off work)
• Long-term economic burden of chronic conditions (e.g., osteoarthritis)
• Impact on athletic careers and related income
• Insurance considerations and coverage limitations

Understanding these economic factors can help in developing cost-effective treatment strategies and highlighting the importance of prevention programs. It also underscores the need for comprehensive insurance coverage and support systems for those affected by knee ligament injuries.

Future Directions in Knee Ligament Injury Research and Treatment

The field of knee ligament injury management continues to evolve, with several exciting areas of research and development:

• Tissue engineering for ligament regeneration
• Gene therapy to enhance healing and prevent re-injury
• Nanotechnology applications in diagnosis and treatment
• Personalized medicine approaches based on genetic profiling
• Advanced biomaterials for improved surgical outcomes

These areas of research hold promise for developing more effective, less invasive, and potentially curative treatments for knee ligament injuries in the future. Ongoing clinical trials and translational research efforts are crucial for bringing these innovations from the laboratory to clinical practice.

As our understanding of knee ligament injuries continues to grow, so does our ability to prevent, diagnose, and treat these conditions effectively. By staying informed about the latest developments and working closely with healthcare providers, individuals can optimize their knee health and maintain an active, fulfilling lifestyle.

Making Knees New Again | Johns Hopkins Medicine

How are your knees? If you’re like many people age 50 and older, they’ve been aching. If you’re 65 or older, you may have some degree of osteoarthritis, in which the cartilage that cushions the ends of the bones in the joints begins to degenerate or wear away.

Symptoms can range from stiffness to severe pain and limited mobility. So it’s probably not surprising that surgeons perform more than 700,000 knee-replacement surgeries in the United States each year.

Total knee replacement is very effective, but implants don’t last forever. Although they can last 20 years, one study found that about 14.9 percent of men and 17.4 percent of women who receive a total knee replacement will need another. The earlier you get your implant, the more likely you’ll be back in surgery at some point.

That’s why knee replacement should only be considered after you’ve tried everything else, says Harpal S. Khanuja, M. D., chief of hip and knee replacement surgery with the Department of Orthopaedic Surgery at Johns Hopkins. That includes following your doctor’s recommendations for losing weight, physical therapy, pain management, and modifying your activities.

“I tell people it’s time for a replacement when they can’t live the life they want to live; it is not a good solution for an occasional pain,” Khanuja says.

To keep knee replacement as a last resort, keep your knees healthy with these smart steps.

Hit a healthy weight.

Weight management is one of the top ways to fight osteoarthritis. Excess weight puts more pressure on your knees. This increases inflammation and likely contributes to disease progression. Every 10-pound loss relieves 30 pounds of force on your knee per step, says Khanuja.

One study found that overweight people who lost just 10 percent of their body weight experienced significantly less knee pain, could walk faster, and moved better. They also had lower levels of inflammation.

Get the right kind of exercise.

Moderate physical activity won’t increase your risk of osteoarthritis. In fact, by helping you maintain a healthy weight, it can actually reduce the risk. If your knees hurt, however, be smart. Don’t start training for a marathon or join a basketball team. Instead, says Khanuja, try lower-impact exercise such as swimming, walking, or using an elliptical machine.

Toss the high heels.

A study published in the journal Arthritis & Rheumatism found that wearing flat, flexible shoes significantly reduced pressure on knees and helped people with osteoarthritis walk better.

Definitions

Cartilage (kahr-ti-lij): Tough, flexible tissue that covers the ends of bones, allowing our joints to move without pain or friction. It also is what gives shape to our noses, ears and windpipe. When cartilage becomes damaged or inflamed, movement can be painful or limited.

Inflammation (in-fluh-mey-shun): The redness and warmth around a cut or scrape is short-term inflammation, produced by the immune system to aid healing. But another type called chronic inflammation, triggered by compounds from abdominal fat, gum disease and other factors, lingers in the body. Research suggests this type increases the risk for heart disease, diabetes, dementia and some forms of cancer.

Knee Ligament Injuries: Causes, Symptoms & Treatment

Knee ligament injuries can cause pain, instability, and interfere with sports and activities, but can be resolved with expert care.

Make an appointment

206.520.5000

Knee ligament injuries can cause pain, instability, and interfere with sports and activities, but can be resolved with expert care.

Make an appointment

206.520.5000

Key points about knee ligament injuries

• Knee ligaments are the short bands of elastic tissue that holds the knee together. There are 4 main ligaments in each knee.
• Knee ligament injuries can be caused by trauma, such as a car accident. Or they can be caused by sports injuries.
• The anterior cruciate ligament (ACL) is one of the most common ligaments to be injured.
• Treatment may include medicine, muscle-strengthening exercises, a knee brace, or surgery.

What is a knee ligament injury?

Knee ligaments are the short bands of tough, flexible connective tissue that hold the knee together. Knee ligament injuries can be caused by trauma, such as a car accident. Or they can be caused by sports injuries. An example is a twisting knee injury in basketball or skiing.

The knee has 4 major ligaments. Ligaments connect bones to each other. They give the joint stability and strength. The 4 knee ligaments connect the thighbone (femur) to the shin bone (tibia). They are:

• Anterior cruciate ligament (ACL). This ligament is in the center of the knee. It controls rotation and forward movement of the shin bone.
• Posterior cruciate ligament (PCL). This ligament is in the back of the knee. It controls backward movement of the shin bone.
• Medial collateral ligament (MCL). This ligament gives stability to the inner knee.
• Lateral collateral ligament (LCL). This ligament gives stability to the outer knee.

What are the symptoms of a knee ligament injury?

Cruciate injury

A cruciate ligament injury often causes pain. Often you may hear a popping sound when the injury happens. Then your buckles when you try to stand on it. The knee also swells. You also are not able to move your knee as you normally would. You may also pain along the joint and pain when walking.
The symptoms of a cruciate ligament injury may seem like other health conditions. Always see your healthcare provider for a diagnosis.

Collateral ligament injury

An injury to the collateral ligament also causes the knee to pop and buckle. It also causes pain and swelling. Often you will have pain at the sides of the knee and swelling over the injury site. If it is an MCL injury, the pain is on the inside of the knee. An LCL injury may cause pain on the outside of the knee. The knee will also feel unstable, like it is going to give way.

When should I contact my doctor?

Seek care immediately if:

• You’re unable to walk or move your leg.
• You have an obvious deformity of the knee or leg.

Call your doctor if:

• Your knee locks or catches or makes a clicking, popping or grinding sound.
• Your knee is painful and/or swollen.
• Your knee feels weak or buckles.
• You are unable to fully bend or straighten your knee.
• You have lost trust in your knee to perform activities without problems.

To have your knee injury evaluated, schedule an appointment with a sports medicine doctor or primary care physician. They can make a diagnosis and, if needed, refer you to a hip and knee orthopedic surgeon for further care.  

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Knee ligament injury care at UW Medicine

Choosing UW Medicine for your orthopedic and sports medicine care means getting access to some of the most experienced physicians and surgeons in the country, many of whom have spent years caring for elite and high-level athletes who have ligament and meniscus injuries. The UW Medicine team helps care for athletes from the Seattle Seahawks, Washington Huskies and many youth sports leagues. 

Treatment plans for most knee injuries rely on making an accurate diagnosis with a focus on managing pain and rehabilitation to regain function. Surgery may also be necessary to lead to full, functional recovery. Our goal is to restore and optimize the function of your knee so you can get back to the activities you enjoy.

Knee and other sports injuries can be evaluated at any of our sports medicine clinics or orthopedic surgery locations across the Puget Sound region. Physicians and surgeons at the Sports Medicine Center at Husky Stadium are specifically trained in treating elite and high-level athletes of all ages. Most UW Medicine physicians train the next generation of doctors, so you can expect to receive care from doctors who have a wealth of experience and also drive future research and education within sports medicine.

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What causes a knee ligament injury?

Cruciate ligaments

The ACL is one of the most common ligaments to be injured. The ACL is often stretched or torn during a sudden twisting motion. This is when the feet stay planted one way, but the knees turn the other way. Slowing down while running or landing from a jump incorrectly can cause ACL injuries.  Skiing, basketball, and football are sports that have a higher risk for ACL injuries.

The PCL is also a common ligament to become injured in the knee. But a PCL injury usually occurs with sudden, direct hit, such as in a car accident or during a football tackle.

Collateral ligaments

The MCL is injured more often than the LCL. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee. This can happen when playing hockey or football.

How is a knee ligament injury diagnosed?

Your healthcare provider will ask you to have your health history and do a physical exam. You may also need one or more of these tests:

• X-ray. This imaging test can rule out an injury to bone instead of a ligament injury. It uses energy beams to make images of internal tissues, bones, and organs on film.
• MRI. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures within the body. It can often find damage or disease in bones and a surrounding ligament, tendon, or muscle.
• Arthroscopy. This procedure is used to diagnose and treat joint problems. The healthcare provider uses a small, lighted tube (arthroscope) put into the joint through a small cut (incision). Images of the inside of the joint can be seen a screen. The procedure can assess joint problems, find bone diseases and tumors, and find the cause of bone pain and inflammation.

How is a knee ligament injury treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

• Pain medicine such as ibuprofen
• Muscle-strengthening exercises
• Protective knee brace
• Ice pack to ease swelling
• Surgery

Knee pain: causes, treatment, which doctor to consult

According to statistics, about 80% of people have experienced knee pain. Moreover, a pronounced pain syndrome may be accompanied by other symptoms: a feeling of weakness (as if the legs give way), clicking when moving, stiffness, inability to straighten the leg.

What causes pain in or under the knee? Is there an effective treatment? Which doctor deals with this problem?

Causes of knee pain

The most common reason for knee pain is an injury:

• A fracture of the knee joint is accompanied by very strong, sharp pain. It becomes more intense if you press on the damaged area. With a fracture, the joint swells, so you won’t be able to bend your knee.

• A dislocation is a displacement of bones. Accompanied by swelling of the knee, severe pain syndrome. A dislocation is not as harmless as it might seem. With an injury of this type, the joint capsule is often torn, tendons, nerves, and ligaments are damaged. If you do not turn to an orthopedic traumatologist in time or completely ignore a visit to a specialist, a habitual dislocation may develop. In this case, the joints and bones can move even with a slight load.

• When ligaments and tendons are torn, a crunch is heard, clicks are clearly distinguished during movement. The joint becomes too mobile. The pain is sharp, as if “shooting”. Theoretically, a person can move around, but when walking, the pain in the knee will be more intense.

• A meniscus tear most often involves a strong blow, as a result of which the knee joint begins to hurt, lose mobility, and swell. A torn meniscus often does not act as an independent injury: it is diagnosed in 75% of cases of knee joint injuries. A torn meniscus often occurs in athletes, dancers, and ballet dancers. But such damage also occurs in everyday life – for example, with a sharp movement, heavy physical exertion or a fall.

By the way, about sports. Runners’ knees often hurt – there is even such a thing as runner’s knee syndrome. Runner’s knee syndrome is a common sports injury in which the cartilage tissue of the patella softens and deforms. The injury occurs as a result of high loads on the knees. By the way, it affects not only runners, but also cyclists, fans of hiking, football players.

Which doctor treats knee pain?

If you are worried about knee pain, the logical question is: which doctor to make an appointment with. In case of pain caused by an injury, you should contact an orthopedic traumatologist as soon as possible.

The doctor will conduct a survey and examination of the patient, to clarify the diagnosis, he will send for examination. By the way, with knee injuries, only x-rays are not always prescribed. For example, when a meniscus is torn, it is not informative, so the patient is referred for an ultrasound of the joint or an MRI of the joints. An MRI will allow you to fully “see” the joint and assess its condition. In case of a fracture and dislocation of the knee, an x-ray is recommended (usually in several projections), in some cases an MRI is prescribed.

In addition, to clarify the diagnosis, the results of laboratory tests are required – most often this is a general and biochemical blood test.

Treatment of knee pain

To prescribe effective treatment, you must first identify the cause of the pain syndrome. For example, when a meniscus is torn, anti-inflammatory drugs are prescribed, the knee is fixed with a bandage. Please note that in the treatment of any knee injury, it is important to ensure that the injured area has complete rest. Splints and splints, which are needed for immobilization, will help reduce the load on the joint. Taping is also actively used – the so-called fixation of the joint with adhesive tapes-teips.

Additionally, the patient is prescribed painkillers that stop the pain syndrome. It can be tablets, ointments or gels.

In some cases, surgery is required. So, with a complete rupture of the ligaments of the knee joint, a low-traumatic operation is performed – arthroscopy.

Massage, reflexology, therapeutic exercises also help to cope with pain, strengthen the knee joint, speed up recovery. These methods “work” due to the fact that they help improve muscle tone, activate blood circulation in the knee joint.

The complex of services in the field of traumatology and orthopedics is provided by experienced specialists of the Scandinavian Health Center. The doctors of our multidisciplinary medical center treat injuries and post-traumatic complications, arthrosis, dislocations, bursitis, etc. In our clinic, you can undergo the necessary examinations, visit a physiotherapist, masseur. We offer affordable prices for services, regularly hold profitable promotions.

To make an appointment with a traumatologist, fill out the online form or contact our representatives by phone +7 (495) 645-00-54. You can also use the feedback form.

Knee pain – RZD-Medicine, Orsk

Symptoms The localization and intensity of knee pain may vary depending on the cause of the knee pain. stiffness

– Redness in the knee joint

– Weakness or instability in the knee joint

– Clicking or cracking in the joint

If symptoms are present, it is essential to seek medical attention.

Causes

Knee pain is a fairly common complaint in people and occurs at any age. Pain can be the result of an injury, such as a torn ligament or a damaged meniscus. Knee pain can also be caused by a variety of conditions, including various types of arthritis, gout, and infections, but the most common cause is trauma.

Trauma can damage any of the ligaments, tendons, or fluid-filled sacs that surround the joint, as well as the bones, cartilage, and ligaments that make up the joint itself.

Risk factors

A number of factors can increase the risk of knee problems and pain, including:

– Being overweight. Being overweight or obese puts more stress on the knee joints, even when performing normal physical activities such as walking or climbing or descending stairs.

– Biomechanical problems. Flat feet can significantly increase the risk of knee problems.

– Lack of muscle strength and elasticity. Lack of muscle strength and flexibility are among the leading causes of injury.

– Some sports. When practicing some sports, there is an accentuated load on the knee joint. Alpine skiing with rigid ski boot bindings and a high risk of falls, jumping and turning when playing basketball, and sprinting with frequent dropping of the knee all increase the risk of injury.

– Presence of previous injuries. If there is a history of previous injuries, the likelihood of a knee injury is much higher.

Diagnostics

As a rule, orthopedic or traumatologists deal with these problems. The doctor, first of all, at the consultation is interested in answers to the following questions:

– When did the symptoms appear and how intense are they?

– Does the patient go in for sports and what kind?

– Has the patient noticed pain in the knee before, what was the reason?

After receiving information about the symptoms and medical history, the doctor examines the knee joint.

As a rule, the doctor makes a preliminary diagnosis based on the initial examination. But to confirm the diagnosis, it is often necessary to connect instrumental research methods.

Imaging methods:

– X-ray is the first choice, especially if it is necessary to rule out bone fractures.

– Computed tomography is more informative than radiography and allows diagnosing both bone pathology and changes in soft tissues.

– Ultrasound is a fairly informative method for studying the pathology of muscle and ligament tissue and functional disorders.

– Magnetic resonance imaging – allows very high quality visualization of changes in the soft tissue structures of the knee joint (ligaments, tendons, cartilage and muscles).

Treatment

Conservative treatment:

With minor pain in the knee, a good effect of conservative treatment is possible, which includes various methods of physiotherapy, therapeutic physical culture (exercise therapy), wearing an orthosis, unloading the joint, applying pressure dressings and local application of cold (for acute knee injuries), drug treatment.