研究者詳細 - 原藤　健吾

論文 - 原藤　健吾

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Stat3 as a potential therapeutic target for rheumatoid arthritis

原藤健吾

SCIENTIFIC REPORTS 7 2017年09月

研究論文（学術雑誌）, ISSN 2045-2322

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Local infiltration of analgesia and sciatic nerve block provide similar pain relief after total knee arthroplasty

原藤健吾

JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH 12 2017年07月

研究論文（学術雑誌）, ISSN 1749-799X

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Self-flip Technique of the TightRope RT Button for Soft-Tissue Anterior Cruciate Ligament Reconstruction

Harato Kengo, Niki Yasuo, Toyoda Takashi, Kamata Yusaku, Masumoto Ko, Otani Toshiro, Suda Yasunori

Arthroscopy Techniques 5 （ 2 ） e391 - e395 2016年04月

ISSN 2212-6287

The TightRope RT (Arthrex, Naples, FL) is a suspensory device for anterior cruciate ligament reconstruction. However, there is a potential risk of the button being pulled too far off the lateral femoral cortex into the soft tissue because the adjustable loop is long. The purpose of this article is to present an easy and safe technique for self-flip. As to the preparation of the graft, we draw the first line in the loop of the TightRope RT at the same length as the femoral tunnel, and we draw the second line 7 mm longer than the length of the femoral tunnel as a self-flip line. Concerning passing of the graft, the side sutures are pulled from the lateral side. We stop pulling the sutures just at the self-flip line by holding the graft at the tibial end. The side suture is inclined to the medial side with strong pulling of the suture at full extension of the knee. Then the surgeon pulls the tibial end of the graft to feel a secure positioning of the button on the lateral femoral cortex. Although it has limitations, the present technique is easy and certainly helps surgeons achieve appropriate positioning of the button.

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What are the important surgical factors affecting the wound healing after primary total knee arthroplasty?

Harato Kengo, Tanikawa Hidenori, Morishige Yutaro, Kaneda Kazuya, Niki Yasuo

Journal of Orthopaedic Surgery and Research 2016年01月

Background: Wound condition after primary total knee arthroplasty (TKA) is an important issue to avoid any postoperative adverse events. Our purpose was to investigate and to clarify the important surgical factors affecting wound score after TKA. Methods: A total of 139 knees in 128 patients (mean 73 years) without severe comorbidity were enrolled in the present study. All primary unilateral or bilateral TKAs were done using the same skin incision line, measured resection technique, and wound closure technique using unidirectional barbed suture. In terms of the wound healing, Hollander Wound Evaluation Score (HWES) was assessed on postoperative day 14. We performed multiple regression analysis using stepwise method to identify the factors affecting HWES. Variables considered in the analysis were age, sex, body mass index (kg/m²), HbA1C (%), femorotibial angle (degrees) on plain radiographs, intraoperative patella eversion during the cutting phase of the femur and the tibia in knee flexion, intraoperative anterior translation of the tibia, patella resurfacing, surgical time (min), tourniquet time (min), length of skin incision (cm), postoperative drainage (ml), patellar height on postoperative lateral radiographs, and HWES. HWES was treated as a dependent variable, and others were as independent variables. Results: The average HWES was 5.0 ± 0.8 point. According to stepwise forward regression test, patella eversion during the cutting phase of the femur and the tibia in knee flexion and anterior translation of the tibia were entered in this model, while other factors were not entered. Standardized partial regression coefficient was as follows: 0.57 in anterior translation of the tibia and 0.38 in patella eversion. Conclusions: Fortunately, in the present study using the unidirectional barbed suture, major wound healing problem did not occur. As to the surgical technique, intraoperative patella eversion and anterior translation of the tibia should be avoided for quality cosmesis in primary TKA.

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Anterior cruciate ligament reconstruction does not fully restore normal 3D knee kinematics at 12 months during walking and walk-pivoting

Hasegawa Takayuki, Otani Toshiro, Takeda Kentaro, Matsumoto Hideo, Harato Kengo, Toyama Yoshiaki, Nagura Takeo

Journal of Applied Biomechanics 31 （ 5 ） 330 - 339 2015年10月

ISSN 1065-8483

The purpose of the current study was to longitudinally evaluate how preoperative knee kinematics change after ACL reconstruction. Three-dimensional gait analysis using the point cluster method was undertaken on the same subjects preoperatively and at 3, 6, and 12 months after ACL reconstructive surgery. Thirteen subjects (7 males, 6 females) were examined while performing 2 different activities at self-selected speeds: walking and walk-pivoting (walking, pivoting toward the landed limb side and walking away). The contralateral knees of subjects at 12 months postoperatively were selected as control knees. Flexion range in the stance phase increased with time after surgery, but remained lower than in the contralateral knee, even at 12 months postoperatively (P <.05) during walking and walk-pivoting. The rotation pattern during walking and walk-pivoting showed an offset toward external rotation by 6 months postoperatively compared with control knees, while at 12 months postoperatively the offset had nearly disappeared and the movement pattern resembled that in control knees. These findings suggest that a return to sport participation by 6 months after ACL reconstruction requires careful consideration. Depending on the type of sport, activity restriction even after 12 months may need to be considered to allow complete kinematic restoration.

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Effects of femoral bone tunnel characteristics on graft-bending angle in double-bundle anterior cruciate ligament reconstruction

Niki Yasuo, Nagai Katsuya, Harato Kengo, Suda Yasunori, Nakamura Masaya, Matsumoto Morio

Knee Surgery, Sports Traumatology, Arthroscopy 2015年08月

ISSN 0942-2056

Purpose: Bone tunnel creation techniques influence the 3-dimensional (3D) position of bone tunnels and graft-bending angle in anterior cruciate ligament (ACL) reconstruction. This study assessed graft-bending angle and 3D characteristics of femoral bone tunnels and compared them between outside-in (OI) and transportal (TP) techniques. Methods: Participants comprised 64 patients who underwent anatomic double-bundle ACL reconstruction, allocated to OI and TP groups (n = 32 each). The graft orientation plane exhibiting the largest graft-bending angle at the femoral tunnel aperture with the knee in extension was reconstructed from CT data using 3D imaging software. In this plane, graft-bending angle was compared between the OI and TP techniques. Results: Although positionings of the intra-articular apertures of the femoral and tibial bone tunnels were similar, several spatial parameters of bone tunnels differed between techniques. Graft-bending angles of both anteromedial and posterolateral bundles were significantly more acute with the OI technique than with the TP technique. On coronal-plane CT, angle of the bone tunnel axis relative to the distal condylar axis correlated negatively with graft-bending angle, while in the axial plane, angle of the bone tunnel axis relative to the posterior condylar axis correlated positively with graft-bending angle. Lysholm score, pivot shift test, and anteroposterior laxity at >2.5-year follow-up demonstrated no significant differences between techniques. Discussion: Different bone tunnel directions in OI and TP techniques substantially affected graft-bending angle, despite similar positionings of the intra-articular apertures. Graft-bending angle with the OI technique was acute, but risk of posterior blowout of the lateral femoral condyle was decreased. Surgeons should create the femoral tunnel while considering an obtuse graft-bending angle without increasing the risk of posterior blowout. Level of evidence: III.

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Factors affecting the achievement of Japanese-style deep knee flexion after total knee arthroplasty using posterior-stabilized prosthesis with high-flex knee design

Niki Yasuo, Takeda Yuki, Harato Kengo, Suda Yasunori

Journal of Orthopaedic Science 2015年08月

ISSN 0949-2658

Background: Achievement of very deep knee flexion after total knee arthroplasty (TKA) can play a critical role in the satisfaction of patients who demand a floor-sitting lifestyle and engage in high-flexion daily activities (e.g., seiza-sitting). Seiza-sitting is characterized by the knees flexed >145º and feet turned sole upwards underneath the buttocks with the tibia internally rotated. The present study investigated factors affecting the achievement of seiza-sitting after TKA using posterior-stabilized total knee prosthesis with high-flex knee design. Methods: Subjects comprised 32 patients who underwent TKA with high-flex knee prosthesis and achieved seiza-sitting (knee flexion >145º) postoperatively. Another 32 patients served as controls who were capable of knee flexion >145º preoperatively, but failed to achieve seiza-sitting postoperatively. Accuracy of femoral and tibial component positions was assessed in terms of deviation from the ideal position using a two-dimensional to three-dimensional matching technique. Accuracies of the component position, posterior condylar offset ratio and intraoperative gap length were compared between the two groups. Results: The proportion of patients with >3º internally rotated tibial component was significantly higher in patients who failed at seiza-sitting (41 %) than among patients who achieved it (13 %, p = 0.021). Comparison of intraoperative gap length between patient groups revealed that gap length at 135º flexion was significantly larger in patients who achieved seiza-sitting (4.2 ± 0.4 mm) than in patients who failed at it (2.7 ± 0.4 mm, p = 0.007). Conversely, no significant differences in gap inclination were seen between the groups. Conclusions: From the perspective of surgical factors, accurate implant positioning, particularly rotational alignment of the tibial component, and maintenance of a sufficient joint gap at 135º flexion appear to represent critical factors for achieving >145º of deep knee flexion after TKA.

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Arthroscopic Visualization of Abnormal Movement of Discoid Lateral Meniscus With Snapping Phenomenon

Harato Kengo, Niki Yasuo, Nagashima Masaki, Masumoto Ko, Otani Toshiro, Toyama Yoshiaki, Suda Yasunori

Arthroscopy Techniques 4 （ 3 ） e235 - e238 2015年06月

ISSN 2212-6287

Discoid lateral meniscus with snapping phenomenon is a rare pathologic condition. The purpose of this article is to present an arthroscopic technique for the treatment of discoid lateral meniscus with snapping phenomenon. The patient is placed in the supine position for confirmation of snapping. As the patient's knee bends, it can be confirmed by arthroscopy that the posterior horn of the discoid lateral meniscus moves posteriorly and the central portion of the discoid lateral meniscus moves anteriorly at the same time with snapping at deep flexion angles. The anterior segment of the discoid lateral meniscus is found to be redundant and is often folded. On the contrary, as the patient's knee extends, the central portion is returned to the original position accompanied by snapping at nearly full extension. After excision of the central portion, the movement of the meniscus is evaluated again and the disappearance of the snapping phenomenon can be confirmed. Although it includes limitations, this application is easy and would certainly help surgeons to treat snapping knee with discoid lateral meniscus.

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Three-dimensional knee kinematics in patients with discoid lateral meniscus during gait

Harato Kengo, Sakurai Aiko, Kudo Yutaka, Nagura Takeo, Masumoto Ko, Otani Toshiro, Niki Yasuo

Knee 2015年03月

ISSN 0968-0160

Background: To date, the knee kinematics of discoid lateral meniscus (DLM) has not been elucidated. The aim was to investigate the three-dimensional knee kinematics in DLM using gait analysis. Methods: Ten patients (mean: 14. years) diagnosed with bilateral DLM and unilaterally symptomatic snapping as well as 10 healthy controls (mean: 23. years) participated in the study. Each patient with DLM had unilaterally snapping knee in full extension and deep flexion. The three-dimensional gait analysis was performed with the point cluster technique. All subjects were asked to walk on a level floor at the speed of their choice. In the sagittal plane, knee excursion was separately evaluated during the weight acceptance phase and the mid-stance phase. In the axial plane, knee excursion during the stance phase was assessed. Finally, knee excursion during the whole gait cycle was evaluated in the frontal plane. Statistical comparison was conducted between groups, and between both sides in the DLM group. Results: In the sagittal plane, knee excursions during the weight acceptance phase and the mid-stance phase were significantly smaller in the DLM group than in the control group; in addition, these were smaller on the symptomatic side than on the asymptomatic side in the DLM group. In the axial plane, knee excursion was also significantly smaller on the symptomatic side than on the asymptomatic side in the DLM group, whereas the frontal knee motion did not differ significantly. Conclusion: Less knee motion in the sagittal plane may prevent snapping during extension and flexion in patients with DLM. Level of Evidence: III.

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What are the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty?

Harato Kengo, Maeno Shinichi, Tanikawa Hidenori, Kaneda Kazuya, Morishige Yutaro, Nomoto So, Niki Yasuo

Knee Surgery, Sports Traumatology, Arthroscopy 2015年03月

ISSN 0942-2056

Purpose: It was hypothesized that surgical time of beginners would be much longer than that of experts. Our purpose was to investigate and clarify the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty (TKA) as a multicentre study.Methods: A total of 300 knees in 248 patients (averaged 74.6 years) were enrolled. All TKAs were done using the same instruments and the same measured resection technique at 14 facilities by 25 orthopaedic surgeons. Surgeons were divided into three surgeon groups (four experts, nine medium-volume surgeons and 12 beginners). The surgical technique was divided into five phases. Detailed surgical time and ratio of the time in each phase to overall surgical time were recorded and compared among the groups in each phase. A total of 62, 119, and 119 TKAs were done by beginners, medium-volume surgeons, and experts, respectively.Results: Significant differences in surgical time among the groups were seen in each phase. Concerning the ratio of the time, experts and medium-volume surgeons seemed cautious in fixation of the permanent component compared to other phases. Interestingly, even in ratio, beginners and medium-volume surgeons took more time in exposure of soft tissue compared to experts. (0.14 in beginners, 0.13 in medium-volume surgeons, 0.11 in experts, P < 0.05).Conclusion: Beginners took more time in exposure and closure of soft tissue compared to experts. Improvement in basic technique is essential to minimize surgical time among beginners. First of all, surgical instructors should teach basic techniques in primary TKA for beginners.Level of evidence: Therapeutic studies, Level IV.

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Effects of Reduction Osteotomy on Gap Balancing During Total Knee Arthroplasty for Severe Varus Deformity

Niki Yasuo, Harato Kengo, Nagai Katsuya, Suda Yasunori, Nakamura Masaya, Matsumoto Morio

Journal of Arthroplasty 2015年01月

ISSN 0883-5403

This study aimed to assess the effects of down-sizing and lateralizing of the tibial component (reduction osteotomy) on gap balancing in TKA, and the clinical feasibility of an uncemented modular trabecular metal tibial tray in this technique. Reduction osteotomy was performed for 39 knees of 36 patients with knee OA with a mean tibiofemoral angle of 21° varus. In 20 knees, appropriate gap balance was achieved by release of the deep medial collateral ligament alone. Flexion gap imbalance could be reduced by approximately 1.7° and 2.8° for 4-mm osteotomy and 8-mm osteotomy, respectively. Within the first postoperative year, clinically-stable tibial component subsidence was observed in 9 knees, but it was not progressive, and the clinical results were excellent at a mean follow-up of 3.3years.

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Pseudogout at the knee joint will frequently occur after hip fracture and lead to the knee pain in the early postoperative period

Harato Kengo, Yoshida Hiroki

Journal of Orthopaedic Surgery and Research 10 （ 1 ） 2015年01月

Background: Symptomatic knee joint effusion is frequently observed after hip fracture, which may lead to postoperative knee pain during rehabilitation after hip fracture surgery. However, unfortunately, very little has been reported on this phenomenon in the literature. The purpose of the current study was to investigate the relationship between symptomatic knee effusion and postoperative knee pain and to clarify the reason of the effusion accompanied by hip fracture. Methods: A total of 100 patients over 65 years of age with an acute hip fracture after fall were prospectively followed up. Knee effusion was assessed on admission and at the operating room before the surgery. If knee effusion was observed at the time of the surgery, synovial fluid was collected into syringes to investigate the cause of the effusion using a compensated polarized light microscope. Furthermore, for each patient, we evaluated age, sex, radiographic knee osteoarthritis (OA), type of the fracture, laterality, severity of the fracture, and postoperative knee pain during rehabilitation. These factors were compared between patients with and without knee effusion at the time of the surgery. As a statistical analysis, we used Mann-Whitney U-test for patients' age and categorical variables were analyzed by chi-square test or Fisher's exact test. Results: A total of 30 patients presented symptomatic knee effusion at the time of the surgery. In patients with knee effusion, numbers of intertrochanteric fracture, radiographic knee OA, and postoperative knee pain were significantly large compared to those without effusion. In terms of synovial fluid analysis, calcium pyrophosphate dihydrate crystals were observed in 80% of patients with knee effusion. Conclusion: From our study, approximately 63% of patients with knee effusion at the time of the surgery had postoperative knee pain. In addition, this effusion was basically related to pseudogout.

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【変形性膝関節症の診断と治療】診断・評価の進歩歩行解析変形性膝関節症患者の歩行解析

原藤健吾，二木康夫，畔柳裕二，大谷俊郎，須田康文，名倉武雄

別冊整形外科 67 66 - 70 2015年

骨付き膝蓋腱を用いた前十字靱帯再々建術のMRI輝度変化とKT値の関係について

金子陽介，二木康夫，窪田秀次郎，箱崎彰裕，原藤健吾，戸山芳昭，須田康文

JOSKAS (日本関節鏡・膝・スポーツ整形外科学会雑誌） 40 134 - 135 2015年

血液型不適合生体肝移植後に人工膝関節全置換術を施行した1例

西村空也，石川雅之，藤田順之，原藤健吾，朝本俊司，西山誠，福井康之

JOSKAS (日本関節鏡・膝・スポーツ整形外科学会雑誌） 40 500 2015年

Effect of unstable meniscal injury on three-dimensional knee kinematics during gait in anterior cruciate ligament-deficient patients

Harato Kengo, Niki Yasuo, Kudo Yutaka, Sakurai Aiko, Nagura Takeo, Hasegawa Takayuki, Masumoto Ko, Otani Toshiro

Knee 2014年12月

ISSN 0968-0160

Background: Our purpose was to clarify the differences of three-dimensional knee kinematics in anterior cruciate ligament (ACL)-deficient patients between with and without meniscal injury using gait analysis. Methods: A total of 72 knees in 36 young athletes with primary and unilateral ACL injury, with a mean age of 22. years, participated. Gait analysis was done before surgery. According to the arthroscopic findings, patients were divided into two groups. The patients with an unstable meniscal tear were allocated to the meniscal injury group (ACL + M group), and the patients without a meniscal tear were allocated to the no meniscal injury group (ACL group). In the gait analysis, three-dimensional knee kinematics was evaluated and compared. Results: The patients in both groups exhibited lower sagittal plane knee excursions and peak knee extension angles on the affected limb than on the unaffected limb during the mid-stance. In terms of the axial plane, a rotation angle was significantly smaller in the affected knees than in the unaffected knees in the ACL group. On the other hand, an opposite phenomenon was observed in the ACL + M group. Moreover, a significantly larger rotation angle in the affected knees during the stance phase and the whole gait cycle was observed in the ACL + M group than in the ACL group. Conclusion: Increased rotational motion during the gait was observed in the ACL-deficient knees combined with unstable meniscal injuries. Meniscal condition may be a key factor for compensatory gait mechanics to prevent rotatory instability in ACL-deficient patients patients. Level of evidence III

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Asymmetry of the knee extension deficit in standing affects weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis

Harato Kengo, Nagura Takeo, Matsumoto Hideo, Otani Toshiro, Toyama Yoshiaki, Suda Yasunori

Knee Surgery, Sports Traumatology, Arthroscopy 22 （ 11 ） 2608 - 2613 2014年10月

ISSN 0942-2056

Purpose: The aim of this study was to evaluate weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis (OA) and to clarify the gait parameters affecting the weight-bearing distribution during both standing and walking using gait analysis.Methods: Twenty-five patients (averaged 71 years) with symptomatic bilateral end-stage medial knee OA participated in this study. They performed relaxed standing, placing one foot on a force plate and thereafter, level walking. First, knee resultant force was calculated on bilateral knees during standing. The knees in each patient were divided into Higher and Lower force side for the definition of dominant side limb. Second, gait parameters in each subject were compared between both sides.Results: Each patient had large weight-bearing asymmetry, though passive range of motion, subjective pain level, femorotibial angle and radiographic disease severities were not significantly different between both sides. In standing, knees on Higher force side were significantly extended (11.2 ± 6.5°) than on Lower force side (14.4 ± 7.3°, P = 0.0086). Similarly, knees on Higher force side were also significantly extended at heel strike during gait. Besides, peak values of extension moment, knee adduction moment, knee adduction moment impulse and vertical force during gait were significantly greater on Higher force side.Conclusions: Ability to extend the knee in standing was considered to be an essential factor to decide loading condition. It is clinically important to examine the ability to extend the knee in standing when considering loading asymmetry during gait in patients with bilateral knee OA.Level of evidence: III.

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Stress fracture of the first metatarsal after total knee arthroplasty

Harato Kengo, Ozaki Masahiro, Sakurai Aiko, Kudo Yutaka, Otani Toshiro

Knee 21 （ 1 ） 328 - 331 2014年01月

ISSN 0968-0160

Stress fractures after total knee arthroplasty (TKA) occur mainly in patients with considerable deformity of the knee. In addition, the majority of these fractures after TKA involve the hip joint. We present two cases of stress fractures of the first metatarsal after TKA in patients with severe varus deformity. Correction of leg alignment and pain reduction obtained by TKA lead to stress fracture of the bone. Gait analysis was carried out for both cases in order to clarify the gait characteristics of the stress fracture. As a result, side-to-side differences of the distance between first metatarsal and foot center of pressure in the coronal plane were observed using gait analysis in these patients. Fortunately, conservative treatment was successful for these patients. Stress fractures should be considered when a patient who had a considerable severe deformity of the knee preoperatively complains of foot pain on the affected side. Contrary to stress fractures at the hip joint, patients with the fracture of the first metatarsal can be treated without surgery. © 2012 Elsevier B.V.

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Erratum to

Tanikawa Hidenori, Matsumoto Hideo, Harato Kengo, Kiriyama Yoshimori, Suda Yasunori, Toyama Yoshiaki, Nagura Takeo

Journal of Orthopaedic Science 19 （ 4 ） 695 - 696 2014年

ISSN 0949-2658

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Female recreational athletes demonstrate different knee biomechanics from male counterparts during jumping rope and turning activities

Tanikawa Hidenori, Matsumoto Hideo, Harato Kengo, Kiriyama Yoshimori, Suda Yasunori, Toyama Yoshiaki, Nagura Takeo

Journal of Orthopaedic Science 19 （ 1 ） 104 - 111 2014年

ISSN 0949-2658

Background: A variety of athletic exercises are performed in sports training or rehabilitation after knee injuries. However, it remains unclear whether males and females exhibit similar joint loading during the various athletic motions. The purpose of this study was to identify gender differences in knee biomechanics during the athletic motions. Methods: Three-dimensional knee kinematics and kinetics were investigated in 20 recreational athletes (10 males and 10 females) while jumping rope, backward running, side running, side-to-side running, side-to-forward running, inside turning, and outside turning. The strengths of the quadriceps and hamstring muscles, the knee joint force, the knee joint angle, and the knee joint moment were compared between males and females using one-tailed t tests. Results: Peak knee anterior force was greater in female recreational athletes than in their male counterparts during jumping rope, side-to-forward running, inside turning, and outside turning. Female subjects displayed greater peak knee abduction angles and greater peak knee flexion moments while jumping rope compared to their male counterparts. There were no significant differences between the sexes in knee kinematics and kinetics in the frontal and transverse planes during running and turning motions. Conclusions: Female recreational athletes exhibited significantly different knee biomechanics compared with male counterparts during jumping rope and turning motions. © The Japanese Orthopaedic Association 2013.

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