Scholarly Activity of the MASH Study Group

As multicenter study group, the physicians and medical professionals of the MASH Study Group are committed to sharing their medical findings in relevant journals and medical publications. Below is a list of the published works of the MASH Study Group’s medical professionals.

Peer Reviewed Publications

1. Kivlan BR Kivlan BR, Nho SJ, Christoforetti JJ, Ellis TJ, Matsuda DK, Salvo JP, Wolff AB, Van Thiel GS, Stubbs AJ, Carreira DS. Multicenter outcomes after hip arthroscopy: epidemiology (MASH Study Group). What are we seeing in the office, and who are we choosing to treat. Am J Orthop. 2017 Jan;46(1):35-41.
   To conclude, the results of this study revealed a predominant demographic of younger to middle aged white females experiencing chronic groin pain. These patients also reported compromised functionality and decline in mental health. Many of these patients had undergone prior surgeries and nonsurgical interventions. This study displayed a high incidence of abnormal hip morphology, especially cam lesions and a low incidence of arthritic changes. Labral tear was the most common diagnosis.
2. Matsuda DK, Wolff AB, Nho SJ, Salvo Jr JP, Christoforetti JJ, Kivlan BR, Ellis TJ, Carreira DS, Hip Dysplasia: Prevalence, Associated Findings, and Procedures From Large Multicenter Arthroscopy Study Group. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018 Feb 1;34(2):444-53.
   In conclusion, the results of this study revealed dysplasia is present in 13% of surgical cases in high-capacity practices. Patients with dysplasia exhibited increased flexed hip internal rotation, largely associated with associated cam deformity. Arthroscopic interventions, including labral repair, femoroplasty, and synovectomy were efficient in managing dysplasia related pathology.
3. Salvo JP, Nho SJ, Wolff AB, Christoforetti JJ, Van Thiel GS, Ellis TJ, Matsuda DK, Kivlan BR, Chaudhry ZS, Carreira DS. Sex-Dependent Differences in Preoperative, Radiographic, and Intraoperative Characteristics of Patients Undergoing Hip Arthroscopy: Results From the Multicenter Arthroscopic Study of the Hip Group. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018 Mar 1;34(3):844-5
   To conclude, this retrospective analysis revealed considerable differences in preoperative hip function, morphology and self-reported functional deficits. Female patients reported heightened preoperative pain levels and functional limitation, whereas male patients displayed higher prevalence of cam deformity and reduced range of motion. Despite these variances, symptom localization, duration and onset showed no significant differences. The observed variations in preoperative functional scores may not represent clinically meaningful differences.
4. Martin RL, Kivlan BR, Christoforetti JJ, Wolff AB, Nho SJ, Salvo JP, Ellis TJ, Van Thiel G, Matsuda DK, Carreira DS. The Impact of Depression on Patient Outcomes in Hip Arthroscopy. The Orthopaedic Journal of Sports Medicine. 2018 Nov 8;6(11):2325967118806490
   In conclusion, this study revealed an evident prevalence of symptoms of depression among patients undergoing hip arthroscopic surgery. This evidence of depression significantly correlates with lower self-reported function, increased pain levels, and reduced satisfaction during the initial appointment and at the 2 year follow up. This study highlights the importance of surgeons recognizing and addressing mental health concerns in patients undergoing hip arthroscopy.
5. Martin RL, Kivlan BR, Christoforetti JJ, Wolff AB, Nho SJ, Salvo Jr JP, Ellis TJ, Van Thiel G, Matsuda D, Carreira DS. Minimal Clinically Important Difference and Substantial Clinical Benefit Values for a Pain Visual Analog Scale After Hip Arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019 Jun 14.
   To conclude, the results of this study established a minimally clinically important difference (MCID) of –15.0 mm and a substantial clinical benefit (SCB) value of –22.7 mm, exhibiting valuable insights for determining pain VAS values during follow up (335 to 395 days post-op). A patient reporting a pain level of ≤10.4 mm is likely to have a normal function rating whereas a patient with a pain level of ≥29.0 mm suggests an abnormal function rate. These results provide surgeons with relevant reference points for assessing patient reported pain and function outcomes.
6. Matsuda, Dean K., Benjamin R. Kivlan, Shane J. Nho, Andrew B. Wolff, John P. Salvo, John J. Christoforetti, Thomas J. Ellis, Dominic S. Carreira, and Multicenter Arthroscopic Study of the Hip (MASH) Study Group. “Arthroscopic Outcomes as a Function of Acetabular Coverage From a Large Hip Arthroscopy Study Group.” Arthroscopy. 35, no. 8 (August 2019): 2338–45.
   In conclusion, the results of this study found no significant differences in the 2 year minimum post operative International Hip Outcome Tool (iHOT-12) among patients with borderline dysplasia, normal coverage and pincer femoroacetabular impingement (FAI). The results signify that lateral acetabular coverage does not significantly impact the success and survivorship of primary hip arthroscopy surgery.
7. Kivlan BR, Martin RL, Christoforetti JJ, Wolff AB, Nho SJ, Salvo Jr JP, Ellis TJ, Van Thiel G, Matsuda D, Carreira DS. The Patient Acceptable Symptomatic State of the 12-Item International Hip Outcome Tool at 1-Year Follow-Up of Hip-Preservation Surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019 Apr 15.
   In conclusion, this study identified a PASS cutoff score of 75.2 for the 12-item International Hip Outcome Tool (iHOT-12) for patients who underwent hip preservation surgery. This score represents a “minimal” target at which patients are likely to be satisfied by the physical state of their hip joint 1 year following hip arthroscopy.
8. Martin RL, Kivlan BR, Christoforetti JJ, Wolff AB, Nho SJ, Salvo Jr JP, Ellis TJ, Van Thiel G, Matsuda DK, Carreira DS. Minimal clinically important difference and substantial clinical benefit values for the 12-item International Hip Outcome Tool. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019 Feb 1;35(2):411-6
   To conclude, the results of this study identified a minimal clinically important difference (MCID) of 13 points and a substantial clinical benefit (SCB) value of 28 points for the International Hip Outcome Tool (iHOT-12), highlighting valuable insights for interpreting scores during a follow up period ranging between 335 and 395 post operative. A patient scoring 85 points or higher indicated a normal rating of function whereas a score of 56 points or lower indicated abnormal rating of function.
9. Bodendorfer BM, Alter TD, Carreira DS, Wolff AB, Christoforetti JJ, Salvo JP, Kivlan BR, Matsuda DK, Nho SJ. Multicenter Outcomes After Hip Arthroscopy: A Comparative Analysis of Two-Year Outcomes After Labral Repair, Segmental Labral Reconstruction or Circumferential Labral Reconstruction. Arthroscopy: The Journal of Arthroscopy and Related Surgery. Accepted 2021.05.12
   In conclusion, this study reveals little to no significant differences in two-year post-op outcomes among those undergoing labral repair (LR), segmental labral reconstruction (SLR), or circumferential labral reconstruction (CLR).  The study’s level of evidence as a therapeutic outcome study with controls elevates the validity of its findings, offering orthopedic surgeons valuable understanding for tailored interventions in the primary setting.
10. Bodendorfer B., Defroda S., Carreira D., et al. Multicenter Outcomes After Hip Arthroscopy: Comparative Analysis of Patients Undergoing Concomitant Labral Repair and Ligamentum Teres Debridement versus Isolated Labral Repair. OJSM. In press: accepted April 2021.
    To conclude, the results of this study reveal that the matched cohorts displayed no significant differences in baseline characteristics, radiographic parameters, or pre- and post-op outcome measures. These results highlight the resilience of patients with concomitant ligamentum teres (LT) pathology, supporting that they experience comparable pre-op scores and achieve similar outcomes as their counterparts with isolated labral tears after hip arthroscopy.
11. Bodendorfer BM, Alter TD, Wolff AB, Carreira DS, Christoforetti JJ, Salvo JP, Matsuda DK, Kivlan BR, Nho SJ. Multicenter Outcomes After Revision Hip Arthroscopy: Comparative Analysis of Two-Year Outcomes After Labral Repair Versus Labral Reconstruction. The American Journal of Sports Medicine. In press: accepted 15 April 2021
    In conclusion, the results of this study revealed no significant differences between the pre-op or two-year post-op patient reported outcomes (PROs). Additionally, the achievement of minimal clinical improvement difference (MCID) and Patient Acceptable Symptomatic State (PASS) did not vary between the two groups for any PRO. This study is beneficial in guiding clinicians in their decision-making processes and emphasizing the importance of tailoring interventions to individual patient characteristics for optimal outcomes.
12. Matsuda D, Kivlan BR, Nho SJ, et al. Arthroscopic Treatment and Outcomes of Borderline Dysplasia With Acetabular Retroversion: A Matched-Control Study From the MASH Study Group. The American Journal of Sports Medicine. June 2021.
    To conclude, this study determines that symptomatic patients with combined borderline dysplasia (BD) and acetabular retroversion (AR) achieved similarly significant and successful outcomes as those with BD or AR alone. The results emphasize the approach required in managing acetabular coverage and the crossover sign (COS) in borderline dysplastic hips with acetabular retroversion, providing valuable insights for clinicians in optimizing treatment strategies for this complex subset of patients undergoing hip arthroscopy.
13. Paravesh K,…Carreira D.S., et al. Achievement of Meaningful Clinical Outcomes is Unaffected by Capsulotomy Type During Arthroscopic Treatment of Femoroacetabular Impingement Syndrome From Multicenter Arthroscopic Study of the Hip (MASH) Study Group. American Journal of Sports Medicine. Published 9 Feb 2021
    In summary, this study found that the choice of capsulotomy type—either interportal or T-type—did not influence the attainment of positive outcomes. Both groups displayed significant clinical improvement, and there were no statistically significant differences in patient reported outcomes (PROs) or the attainment of minimal clinically important difference (MCID), Patient Acceptable Symptomatic State (PASS), and substantial clinical benefit (SCB) between the two capsulotomy techniques. These results highlight that the success of arthroscopic management for femoroacetabular impingement syndrome (FAIS) remains consistent regardless of the capsulotomy type.
14. McGovern RP, Christoforetti JJ, Kivlan BR, Wolf AB, Nho SJ, Salvo JP, Ellis T, Stubbs AJ, Matsuda D, Carreira D. Allocation of Anchors During Labrum Repair: A Multicenter Cohort Analysis of Labral Treatment in Hip Arthroscopy. Orthop J Sports Med. In press: accepted 2020.
    To conclude, the results of this study reveal that the most common tear size spanned a 3-hour arc, with the predominant repair location at the 12- to 3-o’clock position. Notably, this study identified significant variation in the number of anchor implants per tear size. This highlights the importance of tailoring anchor allocation to the size of the labral tear, with a consensus emerging for the fixation of at least 2 anchor points when the mean clockface arc exceeds 2 hours.
15. Arthroscopic Classification of Intra-Articular Hip Pathology Demonstrates at Best Moderate Interrater Reliability. Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). In press: accepted 2020.
    In conclusion, this study found that the interrater reliability of these classifications, except for labral degeneration, was at best moderate. The average kappa coefficients ranged from 0.38 to 0.54, indicating a substantial degree of variability in grading among surgeons. This study emphasizes the complexity of achieving consensus in characterizing intra-articular lesions consistently.
16. Matsuda D, Kivlan BR, Nho SJ,…Carreira, DC. Tenotomy for Iliopsoas Pathology is Infrequently Performed and Associated with Poorer Outcomes in Hips Undergoing Arthroscopy for Femoroacetabular Impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery. February, 2021.
    To conclude, the results reveal that tenotomy in patients with iliopsoas pathology was associated with lower post-op International Hip Outcome Tool-12 (iHOT-12) scores and reduced clinical benefit and patient satisfaction. This study suggests cautious consideration of indiscriminate tenotomy for iliopsoas pathology in femoroacetabular impingement (FAI) arthroscopy.
17. Bodendorfer, B. M., Alter, T. D., Carreira, D. S., Wolff, A. B., Kivlan, B. R., Christoforetti, J. J., … & Nho, S. J. (2022). Multicenter outcomes after primary hip arthroscopy: a comparative analysis of two-year outcomes after labral repair, segmental labral reconstruction, or circumferential labral reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 38(2), 352-361.
    In summary, this study revealed no significant differences in pre-op or post-op scores among the labral repair (LR), segmental labral reconstruction (SLR), and circumferential labral reconstruction (CLR) groups. Additionally, the percentage of patients who achieved significant outcome improvement did not show significant variation based on the type of labral treatment. These results suggest that patients undergoing different labral treatments can display similar outcomes, highlighting the lack of considerable differences in the efficacy of LR, SLR, or CLR procedures.
18. Carreira DS, Shaw DB, Wolff AB, Christoforetti JJ, Salvo JP, R Kivlan B, Matsuda DK. Symptom duration predicts inferior mid-term outcomes following hip arthroscopy. Int Orthop. 2022 Dec;46(12):2837-2843. doi: 10.1007/s00264-022-05579-8. Epub 2022 Sep 10. PMID: 36088416.
    To conclude, the analysis revealed that patients with symptom duration exceeding two years displayed much lower 2-year International Hip Outcome Tool-12 (iHOT-12) scores compared to patients with a symptom duration of less than two years. Logistic regression models also determined that chronic pain duration was a negative predictor of achieving clinically meaningful thresholds. This study suggests that early surgical intervention may be vital for achieving improved mid-term outcomes in patients undergoing primary hip arthroscopy, highlighting the importance of timely management in optimizing results.
19. McGovern RP, Martin RL, Christoforetti JJ, Disantis A, Kivlan BR, Wolff AB, Nho SJ, Salvo JP, Van Thiel GS, Matsuda DK, Carreira DS. Relationship of Average Outcomes Scores and Change in Status Requires Further Interpretation Between 1 and 2 Years Following Hip Arthroscopy. Am J Sports Med. 2022.
    In conclusion, the findings of this study suggest that decisions regarding the outcomes of hip arthroscopy should be postponed until at least the 2-year follow-up, as failure to achieve positive outcomes at 1 year may not accurately predict outcomes at 2 years or beyond. This approach may reduce the need for revision surgery in patients who do not display positive outcomes before the 2-year follow-up, highlighting the importance of a more extended evaluation period.
20. Carreira, D. S., Shaw, D. B., Wolff, A. B., Christoforetti, J. J., Salvo, J. P., Kivlan, B. R., & Matsuda, D. K. (2022). Labral degeneration predicts inferior mid-term outcomes in hip labral repair: A multicenter comparative analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 38(9), 2661-2668.
    In summary, results showed that patients with labral degeneration, who were older on average, had lesser 2-year International Hip Outcome Tool-12 (iHOT-12) scores compared to patients without degeneration. Logistic regression models discovered labral degeneration as a negative predictor for achieving clinically significant thresholds. This study highlights that nondegenerative labral tissue at the time of repair is associated with more progressive mid-term PROs.
21. Carreira, D. S., Shaw, D. B., Ueland, T. E., Wolff, A. B., Christoforetti, J. J., Salvo, J. P., … & Matsuda, D. K. (2022). Acetabular cartilage lesions predict inferior mid-term outcomes for arthroscopic labral repair and treatment of femoroacetabular impingement syndrome. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 38(12), 3152-3158.
    To conclude, results demonstrated that patients with high-grade cartilage lesions had lower 2-year post-op International Hip Outcome Tool-12 ( iHOT-12) scores, and logistic regression models revealed these lesions as negative predictors for achieving substantial clinical benefit (SCB). Low-grade lesions were also identified as negative predictors for achieving minimum clinically important difference (MCID). The study highlights the negative impact of acetabular cartilage damage on patient reported outcomes (PROs) and emphasizes the importance of considering cartilage health in the interest of hip arthroscopy for femoroacetabular impingement (FAI).

Scholarly Presentations

Acetabular retroversion in dysplasia similar prevalence and lower arthroscopic acetabuloplasty rates not influenced by crossover sign compared with non-dysplastic controls.
– Matsuda D, Nho SJ, Wolff AB, Salvo JP, Christoforetti JJ, Ellis T, Kivlan BR, Carreira DS. Presented at American Academy of Orthopaedic Surgeons annual meeting, March 2018.

Defining Number of Anchor Fixation Points For Labrum Refixation: A Multi-center Prospective Cohort Analysis of Suture Anchor Fixation in Arthroscopic Hip Preserving Surgery
– Christoforetti JJ, Kivlan BR, Wolff AB, Nho SJ, Salvo JP, Ellis TJ, Matsuda D, McGovern RM, Stubbs AJ, Carreira DS. International Society of Hip Arthroscopy Meeting; Santiago, Chile; October, 2017. (competitive review)

Iliopsoas Pathology and Procedures from a Large Multicenter Hip Arthroscopy Study Group
– Matsuda D, Nho SJ, Wolff AB, Salvo JP, Christoforetti JJ, Van Thiel GS, Stubbs AJ, Kivlan BR, Carreira DS. International Society of Hip Arthroscopy Meeting; Santiago, Chile; October, 2017. (competitive review). ISAKOS Biannual Meeting; Shanghai, China; June 2017. Western Orthopaedics Association annual meeting; Kauai, Hawaii; August 2017. International Congress for Joint Reconstruction; 3rd Annual Pan Pacific Orthopedic Congress. August, 2016 (competitive review)

The Radiographic Crossover Sign in Dysplasia: Critical Findings Affecting Arthroscopic Surgical Treatments
– Matsuda D, Nho SJ, Wolff AB, Salvo JP, Christoforetti JJ, Van Thiel GS, Stubbs AJ, Kivlan BR, Carreira DS. International Society of Hip Arthroscopy Meeting; Santiago, Chile; October, 2017. (competitive review). Arthroscopy Association of North America annual meeting; Chicago: April 2018. Western Orthopaedics Association annual meeting; Kauai, Hawaii; August 2017

An Analysis of Variability in Surgical Treatments in Hip Arthroscopy
– Carreira DS, Nho SJ, Wolff AB, Salvo JP, Matsuda D, Ellis TJ, Christoforetti JJ, Van Thiel GS, Kivlan BR. Arthroscopy Association of North American Annual Meeting; Denver, CO; May, 2017 (competitive review). Also presented at: American Academy of Orthopedic Surgeon Annual Meeting. San Diego, CA; March, 2017 (competitive review)

Dysplasia: Prevalence, Associated Findings, and Procedures from Large Multi-Center Study
– Matsuda D, Nho SJ, Wolff AB, Salvo JP, Christoforetti JJ, Van Thiel GS, Stubbs AJ, Kivlan BR, Carreira DS. International Congress for Joint Reconstruction; 3rd Annual Pan Pacific Orthopedic Congress. August, 2016 (competitive review). Also presented at: American Academy of Orthopedic Surgeon Annual Meeting. San Diego, CA; March, 2017 (competitive review)

Patterns of Sports Participation in Adolescents Requiring Arthroscopic Hip Preservation Surgery: Does Sport Type Matter?
– Christoforetti JJ, Wolff AB, Nho SJ, Salvo JP, Ellis TJ, Matsuda D, McGovern RM, Stubbs AJ, Kivlan BR, Carreira DS. International Society of Hip Arthroscopy Annual Scientific Meeting; September, 2016 (competitive review). Also presented at: International Congress for Joint Reconstruction; 3rd Annual Pan Pacific Orthopedic Congress; August, 2016 (competitive review)

Gender Patterns in Sports Participation among Athletes Undergoing Arthroscopic Hip Preserving Surgery: Does the ACL Teach Us Anything?
– Christoforetti JJ, Wolff AB, Nho SJ, Salvo JP, Ellis TJ, Matsuda D, McGovern RM, Stubbs AJ, Kivlan BR, Carreira DS. International Society of Hip Arthroscopy Annual Scientific Meeting; September, 2016 (competitive review). Also presented at: International Congress for Joint Reconstruction; 3rd Annual Pan Pacific Orthopedic Congress; August, 2016 (competitive review)

Sex-Dependent Differences in Patients Undergoing Hip Arthroscopy: Prospective Comparison Of Preoperative, Radiographic, and Intraoperative Data From A Large Multicenter Cohort Study (MASH Study Group)
– Salvo JP, Kivlan BR, Nho SJ, Wolff AB, Christoforetti JJ, Van Thiel GS, Matsuda D, Wowkanach G, Carreira DS. International Congress for Joint Reconstruction; 3rd Annual Pan Pacific Orthopedic Congress. August, 2016 (competitive review) Also presented at: American Academy of Orthopedic Surgeon Annual Meeting. San Diego, CA; March, 2017