Winter season and snow sports inevitably increase the risk of injury—particularly to the knee, one of the most vulnerable joints. What are the most common knee injuries? When is conservative treatment appropriate? And is surgery always necessary?

We discuss these questions with Professor Simone Cerciello, orthopedic surgeon specializing in arthroscopic surgery of the shoulder and knee, as well as joint replacement surgery of the knee, shoulder, and hip.

What are the most common knee injuries?

In winter sports-related trauma, the most frequent injuries involve the capsuloligamentous structures. In particular, anterior cruciate ligament (ACL) tears are the most common. Posterior cruciate ligament (PCL) injuries are less frequent, as the PCL is stronger and more resistant. Meniscal tears are also common, while intra-articular fractures are comparatively rare during sports activities.

How important is the mechanism of injury?

The mechanism of trauma provides crucial diagnostic clues.

A twisting injury accompanied by sudden pain, functional impairment, and joint swelling strongly suggests a ligament injury.

Pain occurring without a clear twisting mechanism may be more indicative of a meniscal lesion. However, the clinical progression ultimately guides both patient and specialist.

Minor trauma can usually be managed with:

• A few days of rest

• Cryotherapy (ice therapy)

• Oral anti-inflammatory medication

In many cases, these measures are sufficient to resolve the issue.

Is Conservative Treatment Possible If the Pain Persists?

If pain, functional limitation, or joint swelling persists, consultation with an orthopedic specialist is recommended.

Regarding meniscal injuries, treatment is generally conservative at first—especially in patients who are not highly active young individuals. Meniscal tears are very common in patients over 40, and in this age group, initial conservative management is typically appropriate.

Conservative treatment may include:

• Physical therapy

• Rest

• Anti-inflammatory medication

Surgery is considered only if symptoms and functional limitations persist despite adequate physiotherapy.

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What About Collateral Ligament Injuries?

A distinction must be made between injuries of the medial collateral ligament (MCL) and those involving the lateral compartment.

Isolated MCL injuries can often be treated conservatively with good outcomes. Conversely, injuries affecting the lateral collateral ligament and the posterolateral structures tend to respond less favorably to conservative management.

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When Is Knee Surgery Necessary?

Surgical treatment is generally preferred in cases of anterior cruciate ligament (ACL) rupture.

A short period of conservative treatment may initially be recommended to reduce inflammation and allow joint effusion to subside. This phase may also promote healing of associated bone bruises or trabecular fractures of the tibia, which are very common in ACL injuries following twisting trauma.

Once the knee has stabilized and inflammation has resolved, ACL reconstruction can be performed under optimal conditions.

As for meniscal injuries, conservative therapy remains the first-line approach, as a significant percentage of patients respond well and may not require surgical intervention.