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Chicago surgeon trying for breakthrough to help careers

Rush's Romeo has radical notion of not being so concerned with bicep muscle when repairing shoulders

By David Haugh / Tribune Reporter
July 24, 2010

One day Mario DiCostanzo felt a pop in his left arm after throwing a tennis ball.

Dr. Romeo
Dr. Anthony Romeo performed latissimus tendon surgery on Jake Peavy.
(Chris Sweda, Chicago Tribune)

Next came the feeling of pins and needles in his shoulder and eventually numbness. He had suffered a torn labrum, which for aspiring college pitchers such as DiCostanzo usually precedes the death of a baseball career.

But four months after a minimally invasive, relatively controversial new surgery performed by Dr. Anthony Romeo, the head of shoulder and elbow surgery at Rush University Medical Center, DiCostanzo was playing catch from 10 feet away. Six months after the operation in December 2007, the Hinsdale South graduate was playing long toss from 50-yard distances.

Within a year every bit of velocity on his 80 mph fastball had returned even if, by then, DiCostanzo had decided to forego baseball to concentrate on academics his senior year at Valparaiso University.

"The pain in my arm was completely gone, and I could throw the way I could before the surgery," said DiCostanzo, 22, who still pitches for the DuPage Irish in the South Side Wooden Bat League. "The recovery time was a lot faster than what everybody thought it would be."

If DiCostanzo were a name you were used to reading in a box score, his story would be one Major League Baseball owners, agents and managers used to inspire every pitcher who fears he never will throw another strike after tearing his labrum.

But the prognosis no longer has to be grim thanks to a guy in Chicago who could have an impact on professional baseball more with his surgical gloves than anybody wearing a leather mitt.

His name is Romeo, and he has this romantic notion that his pioneering method, called biceps tenodesis, eventually can help pitchers recover from shoulder injuries as routinely as they do from elbow ligament reconstruction commonly known as "Tommy John surgery."

That breakthrough, named for the former White Sox and Dodgers pitcher who was the first athlete to successful undergo the surgery in 1974, secured surgeon Frank Jobe's legacy to the game. Romeo could be one willing, rehabilitated big-league pitcher away from establishing his.

"We don't have that Tommy John yet," said Romeo, who just received a $50,000 grant from MLB to experiment with cadavers to further explore how the surgery can shorten recovery time and extend careers. "We do have a number of high school- and college-level players (such as DiCostanzo) who have had a (torn labrum), and we've done this surgery, moved the biceps out, and they've gotten back to the same level. We just haven't had an example like that at the major-league level... yet."

Without getting too technical one day last week before he performed a surgery at Oak Park Hospital, Romeo detailed the procedure that impressed Commissioner Bud Selig during a tour of the biomechanics laboratory last month.

Selig raved in a phone interview that, "I see a lot of presentations, but Dr. Romeo's was as good as it gets."

"To get meaningful answers you have to engage in out-of-the-box thinking, and we're going to continue to encourage and fund this type of research," Selig said. "Having run (the Brewers), I know pitching injuries are so unfortunate when they happen to the shoulder, and I've always had the feeling that we need to know more about that area. I was fascinated by what I saw."

The process many in baseball like Selig find so fascinating: To relieve the pain from which a high percentage of patients never recover, Romeo removes the damaged part of the biceps tendon and moves the tendon outside the shoulder joint before attaching it to the upper arm bone. That's where Romeo inserts the tendon into a tiny hole he drilled into the bone and secures it with a screw. The pain vanishes when the strength and range of motion return within a year.

"There is an important interplay between the labrum and the structure that attaches to the upper labrum, the biceps tendon," said Romeo, who operated on Jake Peavy's latissimus tendon. "People don't want to believe that taking the biceps out of the shoulder is a good thing. Many people believe the biceps tendon does play a role in the fine motor control of your shoulder.

"But we've done the research and have the literature that it may play a role, but it's a secondary role. If it's causing the pain that prevents the shoulder from functioning we can eliminate that pain and the rest of the shoulder can make up for the fact that the biceps is not there."

It has worked for tennis players and skiers in Europe, where Romeo once demonstrated the procedure in Italy in front of an audience. It worked for Brett Farve, who Romeo believes was able to play for the Vikings in 2009 only because surgeon James Andrews performed the biceps tenodesis procedure that allowed for a shortened recovery time. It also worked for former All-Star pitcher Curt Schilling, who had the surgery in June 2008 against the Red Sox's wishes but decided to retire before testing his arm at the age of 42 for reasons unrelated to the surgery.

But it only will work for more athletes in the future if they are as willing as Schilling was to take the road less traveled to shoulder recovery.

"The restraint is the concern if you move the biceps and the player doesn't get back, it's the surgeon's fault because we've never really done that before at the major league level," Romeo said. "(But) we may need to say we did the best we could for the past 20 years but need to rethink this whole process, get out of the box and realize the biceps may not play an important role. Then we may be able to get more of these athletes back."

Then maybe a torn labrum won't have to shred a professional pitching career the way it so often does now.

"In 2010 it's grim news to get, but we're hoping that by 2012 to 2015 it'll be like the elbow," Romeo said. "Everybody will be disappointed, it'll be frustrating for the team, but there will be an expectation the athlete will be back to play again next season. This could save many careers."

This could link Romeo's to baseball, forever.

Copyright © 2010, Chicago Tribune
Reprinted by permission

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