Dr. Anthony Romeo: 6 Techniques and Treatments Revolutionizing Shoulder Surgery

Orthopedic Sports Medicine

The shoulder specialty has developed significantly over the past few decades, and more surgeons are now able to conduct research and focus their practices on shoulder-related injuries and conditions. Anthony Romeo, MD, an orthopedic surgeon at Midwest Orthopaedics at Rush and team physician for the Chicago White Sox, has been on the forefront of shoulder research and development for several years and continues to train future specialists in the field.

"When I began practicing in Chicago 18 years ago, I was told there wasn't a place for a shoulder and elbow expert — that I should just focus on sports medicine," he says. "Within a short time, I was able to limit my practice to shoulder and elbow cases, which it has been for the past 18 years. We have built an incredible program of clinical and basic science research here, and our partners are presenting papers on shoulder and elbow research at a rate that has been fairly unprecedented in this arena. We also work with a tremendous number of young, active people who are passionate about this field."

In his practice, Dr. Romeo works closely with Nikhil Verma, MD, Gregory Nicholson, MD, and Brian Cole, MD, on research and development in shoulder care.

Dr. Romeo discusses the following six big techniques and treatments in shoulder surgery today.

1. Throwing injuries in Major League Baseball. An increasing number of players in Major League Baseball are experiencing throwing injuries, with the brunt of these injuries occurring among pitchers. Dr. Romeo and his colleagues have received a $50,000 grant from the MLB to fund their research into the biomechanical principles of pitching and examine the treatments that will most benefit these high-level athletes. "We are looking at methods to better treat injuries that occur in the overhead thrower's shoulder," says Dr. Romeo. "We have learned some very important biomechanical principles that help us treat the pitchers better than we have in the past."

The repeated strain professional pitchers place on their throwing shoulder increases the risk of labrum tears, most often resulting in SLAP tears. These types of injuries can cause pain and loss of stamina and velocity, which is detrimental to a pitcher's success. The traditional method of treatment is an all-arthroscopic SLAP repair where the surgeons reattach the labrum to the shoulder socket using small sutures and anchors, but about one-third of players will still experience postoperative pain.

Dr. Romeo and colleagues has developed a concept that repairing or debriding the SLAP tear can be combined in some patients with a relocation of the bicep tendon without compromising the function of the shoulder. Their study compared the arthroscopic procedure on 20 cadaver shoulder joints to see how the labrum repair with and without the bicep repair affects the biomechanics of the arm. "We are convinced that when the superior labrum surgery doesn't go well and the patients still persist with pain, we have a procedure that can help patients get back to their activity with less pain and often better function," he says.

2. Improved rotator cuff repairs.
Dr. Romeo and his colleagues have conducted  scientific studies on the outcomes of rotator cuff repairs in all types of patients, including patient groups that are considered at risk for poor results. "We have been able to put together our clinical experience to improve the way we treat patients with rotator cuff tears," he says. "Some people believe that after the age of 70 there isn't a reason to repair a rotator cuff tear because it won't heal. We have looked at our patients over the age of 70 and found that clinical success rates are outstanding. If you have patients who are 70 years or older and active, their rotator cuffs will look like they belong to a younger person and there isn't any reason not to repair them."

For younger patients, such as a 35-year-old with a rotator cuff tear, a new surgical technique allows the surgeon to fix the problem after only one procedure. "We've learned to loosen the tendon so if it's been torn for a long time or the patient has had prior surgery, we are able to move the tendon back to where it belongs," says Dr. Romeo. "Once the tendon is back, we've learned how to fix it using a double-row of bone anchors and sutures." The double-row repair secures the torn tendon over a larger area of the bone at this normal attachment site to promote tendon-to-bone healing.

3. Biologics in shoulder repair. The shoulder specialists at Midwest Orthopaedics at Rush have also been working with biologic stimulation of the surgical site to promote healing. The surgeons are applying platelet-rich plasma at the repair site, which stimulates a better healing response. "We're using PRP in any environment where we think the healing is challenged," says Dr. Romeo. "In the best hands, rotator cuff repairs have a 10-20 percent failure rate, so we are using the PRP almost like a bone graft for challenging fractures to reduce the risk of failure. We have also started using stem cells from the humerus and injecting them into the repair site to stimulate a better response."

The surgeons are also using these biologic treatments in some labral repairs when the healing may be challenged. Professional athletes are often prime candidates for biologic solutions because of the strain they place on the shoulder and their goal of returning to a high level of activity post-surgery. "We haven't come to a conclusion yet that PRP makes a difference, but we are trying to add the PRP to increase the healing rate of our patients," says Dr. Romeo.

4. Cartilage restoration.
Along with his colleagues, Dr. Romeo is examining how cartilage restoration can help patients with cartilage deficiency in the shoulder. They have analyzed ways to restore cartilage, reconstruct cartilage lesions and replace shoulders when they become arthritic. In some cases, the surgeons are replanting fresh grafts into the patient's shoulder with the intent of promoting bone to bone healing and reestablishing the cartilage in the socket. The technique was developed along with one of their past fellows, Matthew Provencher, MD, now practicing in San Diego who spent time in the cartilage restoration program at Rush which is directed by Dr. Cole.

"Young people have a cartilage lesion and they come to us because they think they need a shoulder replacement," says Dr. Romeo. "Instead, we have options available to offer a non-replacement procedure to restore the joint." For example, Dr. Romeo worked with a 36-year-old patient who presented a 2 centimeter defect to the articular cartilage. In the past, the patient's only option would have been shoulder replacement, but Dr. Romeo is able to arthroscopically cut out the bad cartilage and replace it with fresh cartilage and bone graft. If the procedure is successful, patients will be able to avoid a shoulder replacement.

5. Anatomic shoulder replacement technology. While preventing shoulder replacement among the appropriate patients is usually the best option, Dr. Romeo and his colleagues have also been working on shoulder replacement devices that will improve outcomes for patients who do need the replacement procedure. "We have been designing shoulder replacement devices that allow us to anatomically reconstruct shoulders using modern techniques," says Dr. Romeo. "We've designed a shoulder replacement for a procedure where the surgeon cuts the bone only at the proper anatomic landmarks and then adjusts the implant to fit the patient's normal bone anatomy."

In the past, shoulder surgeons would cut the patient's humerus so that the implant designed for the general population would fit in the bone. This new technology flips old logic and allows the surgeon to cut the bone where the arthritis is and fit the implant to individual patients, preserving as much of the natural bone as possible. "We can make the replacements much more anatomic, which allows patients to move the shoulder better and functional outcomes are much improved," says Dr. Romeo. "It's made a tremendous difference for patients. Many patients come to us thinking that the shoulder replacement is just a salvage procedure, but we expect our patients to go back to golfing, swimming and other regular activities."

Dr. Romeo has taught courses for surgeons on how to perform the surgical release that loosens up the shoulder. Now, with the anatomically adjustable implants, surgeons only need to fit the implant into the right place during the procedure and perform an adequate release of the contracted shoulder capsule for a better outcome.

6. Treating muscular dystrophy with scapulothoracic fusion. For many surgeons, performing scapulothoracic fusion is a rare occurrence, but Dr. Romeo treats patients with muscular dystrophy from around the country with this procedure on a routine basis. When the condition becomes advanced, the shoulder is unstable and shoulder blades pop outward. The patient cannot raise his arm to the level of his shoulder and may become dependent on others for daily activities. The best way to treat this condition is to remove the muscle under the scapula and fuse the shoulder blade to the 3rd-6th ribs, says Dr. Romeo.

The procedure presents a high risk of pneumothorax, which means the surgeon must use careful technique in the operating room. The surgeon approaches the shoulder from behind and dissects the muscle and tissue before removing the muscle on the scapula. Wires and bone graft are used to fuse the inner shoulder blade to the ribs. The procedure corrects the deformity and often allows patients to complete normal activity without pain.

Learn more about Dr. Anthony Romeo.


Related Articles on Orthopedic Surgery:

Dr. Brian Cole: Developing the Future of Cartilage Regeneration in Orthopedics

The Relevance of Partial Knee Replacements: 7 Things to Know

Anterior Hip Replacements are the Future: 5 Points From Dr. Edward Petrow



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