2025/03/27 更新

写真a

キノシタ トモフミ
木下 智文
Kinoshita Tomofumi
所属
附属病院 助教
職名
助教
連絡先
メールアドレス
外部リンク

学位

  • 博士(医学) ( 2022年3月   愛媛大学 )

研究キーワード

  • キネマティクス

  • 変形性膝関節症

  • 膝関節

  • 人工膝関節全置換術

論文

  • Establishment of a uniform histological evaluation method for early stage osteophytes in the destabilization of the medial meniscus mouse model. 査読 国際誌

    Akihiro Jono, Yuta Yanagihara, Tomofumi Kinoshita, Masaki Takao, Yuuki Imai

    Osteoarthritis and cartilage open   5 ( 4 )   100409 - 100409   2023年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Osteophyte formation is attracting attention as an early-stage pathology of knee osteoarthritis (OA). Although osteophyte formation is understood as a defense response to joint instability, its role and impact on OA remain largely unknown. Many studies have been conducted using the surgical destabilization of the medial meniscus (DMM) mouse model, but there are few standard evaluation methods, especially in the histological evaluation of early-stage osteophytes. The purpose of this study was to establish a reproducible and uniform method for histological evaluation of characteristics of early osteophyte formation in the DMM mouse model. METHODS: Male mice were operated with DMM at 12 weeks old and histologically evaluated at 4 days and 1, 2 and 4 weeks after DMM. Osteophyte Width, Osteophyte Area, and Original and Modified Maturity Scores were used to evaluate osteophytes for all sections. RESULTS: Osteophyte Width, Osteophyte Area and Maturity Scores were all greater anteriorly than posteriorly in the knee joint. The Modified Maturity Score was more strongly correlated with position than the Original Maturity Score, and could be used to evaluate early-stage osteophyte formation. CONCLUSION: The Modified Maturity Score as well as Osteophyte Width and Area at the section of the anterior cruciate ligament (ACL) attachment site can provide a reproducible evaluation method to histologically assess the early-stage osteophyte formation in the DMM mouse model.

    DOI: 10.1016/j.ocarto.2023.100409

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  • Difference in implant design affects midflexion rotational laxity in cruciate-retaining total knee arthroplasty: a computer navigation study. 査読 国際誌

    Takashi Tsuda, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Tomofumi Kinoshita, Masaki Takao

    Journal of experimental orthopaedics   10 ( 1 )   85 - 85   2023年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: This study aimed to compare midflexion rotational laxity between two different design concept models of cruciate-retaining total knee arthroplasty: symmetrical surface design of neutral joint line obliquity and asymmetrical surface design of varus joint line obliquity. METHODS: Sixty-three knees that underwent cruciate-retaining total knee arthroplasty were evaluated. Manual maximum passive rotational stress without acceleration was applied to the knees under navigation monitoring. Pre-operative and post-operative internal and external rotational angles were measured at 30°, 45°, 60°, and 90° knee flexion. RESULTS: The post-operative internal rotational laxity was significantly increased compared with pre-operative levels at 30°, 45°, 60°, and 90° flexion among all subjects (mean 9.7° vs 11.1°, 10.6° vs 11.6°, 11.2° vs 12.9°, and 13.2° vs 14.9°; p = 0.01, 0.04, 0.001, and 0.008, respectively). The post-operative external rotational laxity was significantly decreased compared to pre-operative levels at 30°, 45°, 60°, and 90° flexion among all subjects (mean 10.8° vs 6.8°, 12.5° vs 9.4°, 12.8° vs 10.0°, and 11.3° vs 9.5°; p < 0.0001, < 0.0001, < 0.0001, and 0.0008, respectively). The post-operative total rotational laxity significantly decreased, compared with pre-operative levels, at 30° and 45° flexion among all subjects (mean 20.4° vs 17.9°, and 23.1° vs 21.1°; p = 0.002 and 0.04, respectively). The post-operative total rotational laxity was significantly smaller in asymmetrically designed total knee arthroplasty than in symmetrically designed total knee arthroplasty at 30°, 45°, and 60° flexion (mean 19.3° vs 15.8°, 22.8° vs 18.7°, and 24.4° vs 20.8°; p = 0.03, 0.03, and 0.02, respectively), whereas no significant difference was observed at 90° flexion. CONCLUSION: Compared to symmetrical surface design, asymmetrical surface design resulted in lower rotational laxity at the midflexion range in cruciate-retaining total knee arthroplasty. LEVEL OF EVIDENCE: III.

    DOI: 10.1186/s40634-023-00652-6

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  • Progression of varus deformity in osteoarthritic knees induces anterior paradoxical motion of the femur during early knee flexion 査読

    Tomofumi Kinoshita, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Takashi Tsuda, Masaki Takao

    Knee Surgery, Sports Traumatology, Arthroscopy   2023年3月

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    担当区分:筆頭著者   掲載種別:研究論文(学術雑誌)   出版者・発行元:Springer Science and Business Media LLC  

    DOI: 10.1007/s00167-023-07363-6

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    その他リンク: https://link.springer.com/article/10.1007/s00167-023-07363-6/fulltext.html

  • Feasibility and applicability of locomotive syndrome risk test in elderly patients who underwent total knee arthroplasty 査読

    Toru Ogata, Keiko Yamada, Hiromasa Miura, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Tomofumi Kinoshita, Yasuyuki Ishibashi, Yuji Yamamoto, Tomoyuki Sasaki, Shuichi Matsuda, Shinichi Kuriyama, Mutsumi Watanabe, Tetsuya Tomita, Masashi Tamaki, Teruya Ishibashi, Ken Okazaki, Hideki Mizu-uchi, Shojiro Ishibashi, Yuan Ma, Yoichi M Ito, Kozo Nakamura, Sakae Tanaka

    Modern Rheumatology   2022年11月

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:Oxford University Press (OUP)  

    ABSTRACT

    Objectives

    The concept of locomotive syndrome (LS) and its evaluation method, the LS risk test, have been applied in an integrated manner to capture the decline in mobility resulting from musculoskeletal disorders. The purpose of this study was to evaluate the impact of total knee arthroplasty (TKA) in the elderly with knee osteoarthritis, a common disorder found in LS.

    Methods

    A total of 111 patients were registered prior to TKA and postoperatively followed up for 1 year. Three components of the LS risk test (the two-step test, stand-up test, and Geriatric Locomotive Function Scale-25) were assessed pre- and postoperatively.

    Results

    After surgery, all three components of the test showed significant improvements from the baseline. The ratio of Stage 3 LS patients (progressed stage of decrease in mobility) reduced from 82.3% to 33.9% postoperatively. There was no significant difference in the degree of change in the scores between the younger (60–74 years) and older (≥75 years) age groups.

    Conclusions

    We found that TKA has a major impact in preventing the progression of LS in patients with knee osteoarthritis. The LS risk test is a feasible tool for the longitudinal evaluation of patients with musculoskeletal diseases of varying severity and with multiple symptoms.

    DOI: 10.1093/mr/roac131

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  • Prognostic potential and pathological validation of a diagnostic application using Raman spectroscopy in the characterization of degenerative changes in the cartilage of the humeral head 査読

    Ryuji Asaoka, Hiroshi Kiyomatsu, Hiromasa Miura, Akihiro Jono, Tomofumi Kinoshita, Masaki Takao, Takashi Katagiri, Yusuke Oshima

    Journal of Biomedical Optics   27 ( 11 )   2022年11月

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    掲載種別:研究論文(学術雑誌)  

    Significance: Raman spectroscopy is a well-established analytical method in the fields of chemistry, industry, biology, pharmaceutics, and medicine. Previous studies have investigated optical imaging and Raman spectroscopy for osteoarthritis (OA) diagnosis in weight-bearing joints such as hip and knee joints. However, to realize early diagnosis or a curable treatment, it is still challenging to understand the correlations with intrinsic factors or patients' background. Aim: To elucidate the correlation between the Raman spectral features and pathological variations of human shoulder joint cartilage. Approach: Osteoarthritic cartilage specimens excised from the humeral heads of 14 patients who underwent shoulder arthroplasty were assessed by a confocal Raman microscope and histological staining. The Raman spectroscopic dataset of degenerative cartilage was further analyzed by principal component analysis and hierarchical cluster analysis. Results: Multivariate association of the Raman spectral data generated three major clusters. The first cluster of patients shows a relatively high Raman intensity of collagen. The second cluster displays relatively low Raman intensities of proteoglycans (PGs) and glycosaminoglycans (GAGs), whereas the third cluster shows relatively high Raman intensities of PGs and GAGs. The reduced PGs and GAGs are typical changes in OA cartilage, which have been confirmed by safranin-O staining. In contrast, the increased Raman intensities of collagen, PGs, and GAGs may reflect the instability of the cartilage matrix structure in OA patients. Conclusions: The results obtained confirm the correlation between the Raman spectral features and pathological variations of human shoulder joint cartilage. Unsupervised machine learning methods successfully yielded a clinically meaningful classification between the shoulder OA patients. This approach not only has potential to confirm severity of cartilage defects but also to determine the origin of an individual's OA by evaluating the cartilage quality.

    DOI: 10.1117/1.JBO.27.11.115002

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  • Gender-specific difference in the recurrence of flexion contracture after total knee arthroplasty 査読

    Tomofumi Kinoshita, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Takashi Tsuda, Hiromasa Miura

    Journal of Experimental Orthopaedics   8 ( 1 )   2021年12月

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    担当区分:筆頭著者   掲載種別:研究論文(学術雑誌)   出版者・発行元:Springer Science and Business Media LLC  

    Abstract

    Background

    Range of motion after total knee arthroplasty (TKA) can impact patients’ daily lives. Nevertheless, flexion contracture (FC) often recurs after TKA, even upon achieving full extension intraoperatively. This study aimed to evaluate the relationship among preoperative, intraoperative, and postoperative knee extension angles, and clarify the risk factor for postoperative FC.

    Methods

    One hundred forty-seven knees undergoing TKA using a navigation system were evaluated. We measured the pre- and postoperative (6 months after TKA) extension angles using a goniometer, and intraoperative (before and after TKA) extension angle using a navigation system; the correlation between these angles at each time point was evaluated.

    Results

    The mean preoperative, intraoperative (before and after TKA) and postoperative extension angles were -9.9°, -6.8°, -0.1°, and -2.0°. Regarding intraoperative extension angle after TKA, 58 knees showed ≤ 5° hyperextension and six knees showed &gt; 5° hyperextension. At 6 months, no cases showed hyperextension and 105 knees showed full extension. The mean intraoperative extension angle after TKA in the postoperative full extension group was 0.4°. A significant correlation was found among extension angles at each point (p&lt;0.01, respectively). However, the intraoperative extension angle after TKA correlated with the postoperative extension angle only in females. Contrarily, the recurrence rate of FC was significantly higher in males than in females (p&lt;0.01).

    Conclusion

    Intraoperative extension angles significantly correlated with pre- and postoperative extension angles in TKA. Moreover, intraoperative mild (≤ 5°) hyperextension is acceptable for postoperative full extension. There was a gender-specific difference in correlation between intra- and postoperative knee extension angles.

    Level of evidence

    III.

    DOI: 10.1186/s40634-021-00409-z

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    その他リンク: https://link.springer.com/article/10.1186/s40634-021-00409-z/fulltext.html

  • Efficacy of posterior capsular release for flexion contracture in posterior-stabilized total knee arthroplasty 査読

    Tomofumi Kinoshita, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Takashi Tsuda, Hiromasa Miura

    Journal of Experimental Orthopaedics   8 ( 1 )   2021年12月

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    担当区分:筆頭著者   掲載種別:研究論文(学術雑誌)   出版者・発行元:Springer Science and Business Media LLC  

    Abstract

    Purpose

    Posterior capsular contracture causes stiffness during knee extension in knee osteoarthritis. Furthermore, in posterior-stabilized total knee arthroplasty (PS-TKA), a unique design such as the cam mechanism could conflict with the posterior capsule (PC) causing flexion contracture (FC). However, few studies have focused on the anatomical aspects of the PC. This study aimed to investigate the anatomical site and forms of posterior capsular attachment to the femoral cortex, and to evaluate the efficacy of posterior capsular release for FC by assessing changes in knee extension angles using a navigation system.

    Methods

    Attachment sites of the PC were investigated in 10 cadaveric knees using computed tomography. PS-TKA was performed in six cadaveric knees using a navigation system to evaluate the efficacy of posterior capsular release for FC. Posterior capsular release was performed stepwise at each part of the femoral condyle.

    Results

    The gastrocnemius tendon and PC were integrally attached to the femoral cortex at the medial and lateral condyles, whereas the PC at the intercondylar fossa was independently attached directly to the femoral cortex. Moreover, the PC at the intercondylar fossa was attached most distally among each femoral condyle. Posterior capsular release at the intercondylar fossa allowed 11.4° ± 2.8° improvement in knee extension. This angle was further improved by 5.5° ± 1.3°, after subsequent capsular release at the medial and lateral condyles.

    Conclusion

    The forms and sites of posterior capsular attachment differed based on the part of the femoral condyle. Stepwise posterior capsular release was effective for FC in PS-TKA.

    Level of evidence

    III.

    DOI: 10.1186/s40634-021-00422-2

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    その他リンク: https://link.springer.com/article/10.1186/s40634-021-00422-2/fulltext.html

  • Rotational Soft-Tissue Balance Is Highly Correlated with Rotational Kinematics in Total Knee Arthroplasty 査読

    Tomofumi Kinoshita, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Hiromasa Miura

    The Journal of Knee Surgery   2021年5月

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    担当区分:筆頭著者   掲載種別:研究論文(学術雑誌)   出版者・発行元:Georg Thieme Verlag KG  

    Abstract

    Recovery of normal knee kinematics is critical for improving functional outcomes and patient satisfaction after total knee arthroplasty (TKA). The kinematics pattern after TKA varies from case to case, and it remains unclear how to reproduce normal knee kinematics. The present study aimed to evaluate rotational knee kinematics and soft-tissue balance using a navigation system and to assess the influence of intraoperative soft-tissue balance on the rotational knee kinematics. We evaluated 81 osteoarthritic knees treated with TKA using a posterior stabilized (50 knees) or cruciate retaining (31 knees) prosthesis. Rotational kinematics were assessed at 0, 30, 45, 60, and 90 degrees flexion angles by using a computer-assisted navigation system. Correlation between femorotibial rotational position and measured soft tissue balance was assessed by using Spearman's rank correlation coefficient. Rotational soft-tissue balance (the median angle of rotational stress) was significantly correlated with rotational kinematics (rotational axis of the femur relative to the tibia throughout the range of motion) at all measured angles after TKA. The correlation coefficients between the median angle of rotational stress and rotational kinematics were 0.97, 0.80, 0.74, 0.71, and 0.70 at 0, 30, 45, 60, and 90 degrees of flexion, respectively (p-values &lt;0.0001 in all measured angles). The correlation coefficient increased as the knee approached full extension. Our findings suggest that soft-tissue balance is a key factor for rotational kinematics, following both cruciate-retaining and posterior-stabilized TKA.

    DOI: 10.1055/s-0041-1729619

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  • In vivo anterior cruciate ligament length pattern assessment secondary to differences in the femoral attachment under loading condition using image-matching techniques 査読

    Kazunori Hino, Yoshitaka Shiraishi, Kazuho Nishimatsu, Tatsuhiko Kutsuna, Kunihiko Watamori, Hiroshi Kiyomatsu, Yasumitsu Ishimaru, Tomofumi Kinoshita, Hidehiko Higaki, Hiromasa Miura

    Journal of Orthopaedic Science   24 ( 2 )   294 - 300   2019年3月

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:Elsevier BV  

    DOI: 10.1016/j.jos.2018.09.021

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受賞

  • CAOS international 2024 Clinical Poster Presentation Award

    2024年6月  

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  • 第3回日本人工関節学会 学会賞

    2024年2月   日本人工関節学会  

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  • 公益財団法人 整形災害外科学研究助成財団 「アルケア賞」

    2023年5月   公益財団法人 整形災害外科学研究助成財団  

    木下智文

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  • 令和4年度 愛媛大学医学部附属病院 医学系研究科研究奨励賞

    2022年3月   愛媛大学  

    木下智文

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  • 令和3年度 愛媛大学整形外科学 優秀論文賞

    2022年1月   愛媛大学整形外科同門会  

    木下智文

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  • 第167回愛媛整形外科集談会 優秀演題賞

    2021年12月   愛媛県整形外科医会  

    木下智文

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  • 第159回愛媛整形外科集談会 優秀演題賞

    2020年2月   愛媛県整形外科医会  

    木下智文

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  • 第154回愛媛整形外科集談会 優秀演題賞

    2018年12月   愛媛県整形外科医会  

    木下智文

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