正確的治療方法?

病患者男 - 34歲

CLINICAL HISTORY:
Injury left knee.
Sensation of click.
Lateral + medial tenderness.

MRI Report

FINDINGS:

the knee alignment is normal, there is moderate joint effusion with superior plica.
no popliteal cyst is noted. increased signal seen in the infra-patellar fat pad due to synovitis. some fluid is seen between the inferior patellar tendon and anterior tibial tubercle due to deep bursitis.

there is soft tissue swelling seen medially and involves the medial collateral ligament and is compatible with a grade 1 sprain.

increased signal along the ilio-tibial tract and also between the ilio-tibial tract and lateral femoral condyle compatible with ilio-tibial band syndrome.

there is abnormal signal without thinning of the mid facet patellar articular cartilage.this is due to grade I chondromalacia.

there is no abnormal signal on T2 FS images in the femur, tibia and fibula to suggest fracture or bone oedema / bruises.

on T2* and PD images, there is no abnormal meniscal signal.

The anterior and posterior cruciate ligmaents outline normally. The fibres are well visualized especially on T2 FS images. No evidence of discontinuity. No tear is detected.

there is no abnormality detected in the lateral collateral ligaments. No soft tissue swelling or oedema is seen. No tear is detected.

the patella is normal in position. there is no dislocation. the quadriceps and the inferior patellar tendon are unnremarkable.

COMMENT:
1. moderate joint effusion with superior plica.
2. Sprain MCL.
3. Ilio-tibial band syndrome.
4. Chondromalacia.

本人想提問醫生正確的治療方法? 謝謝。

陳禮樂醫生回覆:
9/19/2018

您好，多謝讀者你的來信。

膝關節皺褶（Knee joint plica syndrome）病變好發於長跑、自行車、階梯運動等這些必須重複彎曲-伸直膝蓋的運動員，但也常於交通事故的患者身上發現。膝關節皺褶病變起因於長期與關節軟骨相互摩擦，引起炎性反應（滑液囊發炎、膝關節腫脹），影響到關節功能性表現；長時間炎症無法解除會造成皺褶纖維化及增厚，甚至導致關節軟骨之磨損與退化。臨床理學檢查可發現膝關節有局部性的壓痛，膝關節彎曲時，會感覺到有喀喀聲響出現。另外，將髕骨推往外側時，會因為內側皺褶的張力變大，而誘發出更明顯的症狀。對於膝關節皺褶（Knee joint plica syndrome）處理原則：
（1）急性發作遵循PRICE運動傷害處理原則，應適當休息。
（2）炎症反應藉由保守療法即可得好良好的控制（超音波治療、手法治療）。
（3）運動的熱身/收操應加強膝關節周邊肌群的伸展運動。
（4）情況無法改善應考慮關節鏡手術的必要性。

祝生活愉快

以上資料只供參考，不能作診症用途，
請與家庭醫生查詢並作出適合治療。
如有身體不適請即求診，切勿延誤治療。
若資料有所漏誤，本網及相關資料提供者恕不負責。