Research by Dr. Carreira

The MASH Study Group

MASH Study GroupThe MASH Study Group is looking to find answers to difficult questions related to the surgical treatment of patients with adolescent and young adult hip injuries.

For further information regarding the MASH Study Group, including participating surgeons, funding and more, please visit our website, mashstudy.com.

Current Research Projects

Validation and inter-observer reliability of a novel descriptive classification system of hip cartilage and synovial lesions

Investigators: Dominic S. Carreira M.D., John J. Christoforetti M.D., John P. Salvo M.D., Andrew B. Wolff M.D., Rob Roy Martin PT Ph.D., Kelly L. Hearne, M.S.Ed., Shane J. Nho M.D., M.S.

The purpose of this study was to determine inter- and intra-observer reliability in defining intra-articular lesions of the central compartment of the hip.

This study involves three phases: 1) the development of a classification system for chondrolabral injuries and synovitis noted during arthroscopic hip surgery; 2) the development of an educational module to instruct surgeons how to properly classify hip injuries using this new system, and 3) the validation and testing of inter and intraobserver reliability for this new classification system, developed by the MASH Study Group. This study was performed in compliance with HIPPA regulations and with approval from the Institutional Review Board.

Dysplasia and Cam Femoroacetabular Impingement with Low Versus High Internal Rotation: Should These be Treated Differently?

Investigators: Dominic S. Carreira, MD, John J. Christoforetti, MD, John P.Salvo, MD, Andrew B. Wolff, MD, Shane J. Nho, MD, Geoffery S. Van Thiel, MD/MBA, Thomas J. Ellis, MD, Dean K. Matsuda, MD, Allston J. Stubbs, MD, MBA, Richard C. Mather III, MD, Misty Suri, MD

This project will be one of the first studies using the de-identified surgical outcome data collected by MASH group surgeons.

By querying the data collected as part of the MASH study both preoperatively and postoperatively at 2 years, lateral center edge angle, documented flexed hip internal rotation, Beighton criteria, and patient reported outcome measures will be assessed. Correlations and other statistical measures will be done to compare surgical outcome measures.

Recently Completed Projects

These projects are closed to enrollment and are currently in the analysis phase. Many of these projects have been presented at national and international conferences and are being prepared or are in the process of journal submission.

Anterior Margin Ratio versus Anterior Center-edge Angle for Assessment of Anterolateral Coverage

Investigators: Dean K. Matsuda, MD, Dominic Carreira, MD, Shane Nho, MD, Steven Needell, MD, Ross Borzykowski, MD

Anterolateral coverage is an important variable in the field of open and arthroscopic hip preservation. Anterolateral overcoverage may cause pincer femoroacetabular impingement; anterolateral undercoverage may cause dysplasia. Both conditions may cause chondrolabral pathology that has been implicated in the pathophysiology of hip osteoarthritis. The purpose of this study is to determine if the anterior margin ratio (AMR) is a better radiographic measurement of anterolateral acetabular coverage than the current gold standard acetabular center edge angle (ACEA).

Conclusions: The AMR as measured on the AP pelvis view provides a more reproducible method of measuring anterior acetabular coverage and may facilitate assessment of intra/perioperative anterior rim changes while minimizing positional variation observed on false profile views. As such, the AMR may become the new gold standard in measuring the all- important anterior acetabular rim.

Arthroscopic Reconstruction of the Acetabular Labrum using Allograft Fascia Lata: Technique and Early Results

Investigators: Dominic S. Carreira, M.D., John Patrick Kozy, B.S., M Russell Giveans, Ph.D.

Acetabular labral tears cannot always be repaired.  Arthroscopic labral debridement alone has been associated with inferior outcomes compared to procedures which restore the labrum.  The purpose of this study was to describe a technique for labrum reconstruction and to determine the efficacy and safety of an all-arthroscopic hip labrum reconstruction using allograft fascia lata.

Conclusion: Patients demonstrated significant improvement with allograft labrum reconstruction.  The shuttle technique is safe and effective and avoids the need to fixate the free end of the graft from inside the joint.  Compared to historical controls of hip arthroscopy, this patient population was older and included a high rate of chondroplasty or microfracture.

CT-Guided Arthroscopic Acetabular Rim Resection

Investigators: Dominic S. Carreira, MD, John Kozy, BS

Although the importance of planning the extent of acetabular rim resection is widely accepted in arthroscopic hip surgery, few guidelines exist for quantifying the amount and location of rim trimming. This study presents a CT scan protocol with accompanying rim resection guidelines for hip arthroscopy.

Conclusions: The proposed rim resection guidelines, rooted in geometric assumptions, facilitate arthroscopic acetabuloplasty planning at three distinct locations on the acetabular rim and accurately predict center edge angle changes for resections less than six millimeters.

The Relationship and Effects of Duration and Amount of Hip Traction on Nerve Injuries During Hip Arthroscopy

Investigators: Dominic S Carreira, MD, John Kozy, BS, Kelly L Hearne, MSEd, Roger J Malcom, MSE

This study examines the short and long term effects of amount of traction and time in traction for hip arthroscopy patients.

Chronic Achilles Tendon Rupture with Percutaneous Repair and Endoscopic Assisted Flexor Hallucis Longus Transfer

Investigators: William Aaron Kunkle, DO, Dominic S Carreira, MD

This case report presents an endoscopically-assisted flexor hallucis longus harvest and transfer for augmentation of a chronic Achille’s tendon rupture.

In Press

Walker R, Kunkle WA, Carreira DS. Arthroscopic Approach to Osteochondral Defects, Impingement, and Instability. Clin Sports Med. 2015 Oct;34(4):689-703.

Carreira DS, Vora AM, Hearne KL, Kozy J. Arthroscopic Treatment of Posterior Impingement of the Ankle: Outcomes Including Range of Motion. Foot and Ankle International. Accepted for Publication September 2015

Carreira DS, Ballard A.  Achilles Tendoscopy.  Foot Ankle Clin. 2015 Mar;20(1):27-40

Needell S, R Borzykowski, D Carreira, J Kozy. CT false profile view of the hip: A reproducible method of measuring anterior coverage using volume CT data. Skeletal Radiol, 2014, 10.1007/s00256-014-1949-8

Hsu A, Gross C, Lee S, Carreira DS.  Extended Indications for Foot and Ankle Arthroscopy. Journal of the American Academy of Orthopedic Surgeons, Vol. 22 (1), January 2014.

Research publications prior to 2014 can be seen here.

Coming Soon!

MASTAF- Multicenter Arthroscopy Study of The Ankle and Foot

Investigators: Dominic S Carreira, MD, James R McWilliam, MD, Thomas Harris, MD, Eric Giza, MD, David N Garras, MD, Emilio Wagner Hitschfeld, MD, Rebecca Cerrato, MD, Anand M Vora, MD, Jorge I Acevedo, MD, Eugene E Curry, MD, Anne H Johnson, MD

Hip Outcome and Performance Study

Principal Investigator: Brian Giordano, MD, Associate Professor, Department of Orthopaedics, University of Rochester Medical Center

Co-Investigators: John Christoforetti MD, Alleghany Health, Andrew Wolff MD , Johns Hopkins University, Washington Orthopaedics & Sports Medicine, Dominic S Carreira, MD, Broward Health Sports Medicine and Orthopedics

International Multicenter Prospective Ankle Study Database on Safety and Efficacy Outcomes of Surgical Stabilization (IMPASS EOSS)

Principal Investigator: Mark Glazebrook, MD, FRCSC, MSc, PhD, Dalhousie University, Halifax, Nova Scotia, Canada

Co-Investigator: Dominic S. Carreira, MD

The goal of this study is to collect efficacy and safety data form patients who have been treated for chronic ankle instability with arthroscopic, minimally invasive or traditional open surgical techniques. It would be the goal of this study to compare any and all surgical ankle stabilization techniques for safety & efficacy.

For further information about Dr. Carreira and the Carreira Research Group’s current study projects, please contact Dr. Carreira’s office.