As a 12-year-old boy, Tom Melgar was playing outside on a February day in Long Island, New York, when he stepped onto the steep bank of a pond. What was normally soft sand had frozen into a slippery surface. He slid into a deep channel of frigid water.
Melgar was in over his head and didn’t know how to swim.
Both banks of the channel were too steep and slick to climb. Despite being weighed down by a winter coat and boots, a flailing Melgar managed to make it about 50 yards across the pond.
“I thought it was the end until my feet touched the bottom on the other side,” he said. “I did not think I was going to survive that.” Melgar’s parents immediately enrolled him in swimming lessons. Once he started, he didn’t want to stop.
Melgar swam for his high school team and qualified for the state meet as a senior. He went on to swim collegiately at Stony Brook University, where he earned his undergraduate and medical degrees.
Melgar, 58, is now a professor of medicine at the Western Michigan University Homer Stryker M.D. School of Medicine and a practicing pediatrician and internist. He continued to swim at an elite level into his 50s. He even placed 10th in his age group in the 50-yard freestyle at the 2013 U.S. Masters Swimming Spring National Championship.
Soon afterward, he had to stop competing because of an injured right shoulder. He originally hurt the shoulder when he took a spill playing softball about 15 years ago. Pain and dysfunction developed and continued to worsen. His range of motion slowly deteriorated until he couldn’t lift his arm above shoulder height.
“It’s a career-ending situation for a lot of swimmers,” Melgar said.
He resisted the idea of a metal-and-plastic shoulder replacement because he didn’t think the artificial joint could stand up to the rigors of swimming. He wondered if a graft of human tissue could work in the shoulder joint, but he couldn’t find much information about that kind of procedure.
In March 2017, Melgar was returning from his annual medical mission trip to the Amazon when he saw an advertisement at O’Hare Airport in Chicago.
“It said, ‘BioJoint,’ ” Melgar recalled. “I didn’t know what that was, and it was on an electronic screen, so it blinked off. I just remembered the name and looked it up when I got home.”
That’s when he found MU Health Care’s Mizzou BioJoint® Center, which offers biological solutions to ankle, knee, hip and shoulder problems. Surgeons use donated cartilage and bone to restore joints — a procedure known as an osteochondral allograft transplantation. Using precision medicine — personalized treatment designed for a patient’s specific needs — the Mizzou BioJoint® Center team selects grafts matched to the specific shape and size of the recipient’s joint to help the graft more seamlessly integrate into the patient’s body.
Melgar was intrigued and came to Columbia to see if a BioJoint surgery would work for him. Matt Smith, MD, a surgeon who specializes in shoulders and elbows, met with Melgar and gave him the opposite of a hard sell. Previously, Smith had only performed BioJoint shoulder procedures to address problems such as chronic dislocation or fractures.
“He had really advanced changes in the shoulder cartilage and bone for a young person and significant loss of motion,” Smith said.
After peppering Smith and James Cook, DVM, PhD, the Mizzou BioJoint® Center’s director of operations and research, with what he described as “tons of questions” for almost a year, Melgar decided to have surgery. In March 2018, Cook let him know the BioJoint team had identified a MOPS graft that matched his measurements.
Developed by Cook and a team of University of Missouri researchers, MOPS — short for Missouri Osteochondral Preservation System — extends the storage life of donated tissues. By combining MOPS with a technique that loads the patient’s own bone marrow cells into a customized graft, the Mizzou BioJoint Center has used precision medicine to refine the osteochondral allograft transplantation procedure.
Smith performed the procedure, replacing the surface of Melgar’s humeral head — the ball portion of the long bone of the upper arm — with donor bone and cartilage. He also reshaped the socket, which had become asymmetrical from bone-on-bone rubbing.
Melgar then began a rehabilitation process tailored to his lifestyle and goals. Rehab required patience as he allowed the grafts time to heal and integrate into his body. For the first two months after surgery, he didn’t swim at all. For the next four months, he swam without using his right arm. Then, he gently began using his right arm on strokes. Finally, a year after surgery, he started putting some force into his strokes.
“I’m really quite surprised that almost every day is noticeably better than the previous day,” Melgar said. “It’s hard to imagine I’m 500 days out from surgery, and there are that many little differences that I can feel, like, ‘I swam this morning, and it definitely felt better than the previous day.’ ”
Melgar has regained almost normal range-of-motion in the shoulder. He estimates that he has swum 35,000 to 40,000 miles in his lifetime, and he doesn’t plan to stop soon. On Nov. 16, he competed in his first meet since his surgery. He hopes to swim at the national championships in 2020.
“I’m not swimming in the fast lane now because I was so limited for so long,” Melgar said, “but I’ll get back there.”
— Before deciding on a BioJoint procedure, it’s important for patients to discuss with their doctor the risks and benefits of surgery for their condition.