How many American pediatric orthopedists are also sports medicine experts? Less than 20, says Dr. Paul Saluan, a member of this select group, and an orthopedic surgeon at Cleveland Clinic.
A native of Cleveland, Paul Saluan was the youngest of seven children. “My father emigrated from Lebanon and unfortunately was not able to get much formal education. My mother was a stay at home mom who dealt with the rigors of raising seven children while my father went to work. Being the child of immigrants you don’t take for granted the freedoms that are available in the U.S. My dad always said, ‘You are lucky to be here. Remember that we worked hard to get to this country.’”
Also guiding the early life of Paul Saluan were those from a rigorous intellectual and moral background.
I had a Jesuit education all throughout lower school and high school. Not only was the education unrivaled, but their moral credo stands apart: become a man for others. This impressed upon me the importance of taking care of people, of giving one’s time and going beyond the self for others.”
But it wasn’t a “father” who guided the young Paul Saluan towards medicine…it was an uncle. “My father’s brother was a general surgeon. By watching him work, I developed a fascination with the workings of the human heart—in essence, a real thirst for knowledge regarding this perfect machine that runs for our entire lives.”
Finding his Niche in Medicine
He decided to tackle orthopedic surgery in part because of his experience on the football field. “I spent my undergraduate years at John Carroll University in Cleveland, where I majored in biology and was an outside linebacker for four years. Just after graduating college, I met Deborah, the love of my life. She had just graduated from Notre Dame College with a degree in business management and was a personal trainer—a perfect fit for me given my love of sports.”
When I got to Case Western Medical School, it was an easy decision to go into orthopedics. It fit my love of sports, as well as my tendency to be concrete and to enjoy fixing problems.
After Dr. Saluan realized that orthopedics was a good fit for him, he entered a residency at Cleveland Clinic. “The intern year was very difficult because my dad became ill and spent the last three months of his life at Cleveland Clinic. Deborah, my family, friends and colleagues at Cleveland Clinic were all amazingly supportive throughout the ordeal.”
Glad to have such engrossing work during a difficult time, Dr. Saluan plunged into his education.
“The program was unusual in that we had mini internships with each doctor, which involved lots of one on one time in the clinic, office and OR. My interest in pediatric orthopedic surgery developed in my third year and was enhanced by my time with Dr. Alan Gurd, the head of pediatric orthopedics, as well as Drs. Jack Andrish, and Tom Kuivila. I could see that I would like this field because you A) identify the problem, B) Treat the problem and C) the patient moves on and usually does quite well. Two more pediatric rotations and a realization that Cleveland Clinic attracts interesting, complex cases solidified my decision to become a pediatric orthopedist.”
Then a visiting professor with a magnetic personality pulled Dr. Saluan in a westerly direction. “Dr. Bob Eilert, the fellowship director at Denver Children’s Hospital, had come to Cleveland Clinic in my fourth year. His easygoing style and charisma really captured people. One of my more senior colleagues in residency was just finishing his fellowship there, and highly recommended it. He was right: it ended up as my best year of training. Denver being a regional hub, we saw lots of complex children’s issues, including pediatric sports injuries.”
Building Practices of his Own
Growing up in a large family, Dr. Saluan has always appreciated hearth and home…thus it was back to Ohio for him. “My wife and I enjoyed Denver, but our families are from the Midwest, and we thought it would be too difficult to live there and maintain good relationships from a distance. So in 1999 I went into practice in Akron at Crystal Clinic, a group with more than 20 orthopedic surgeons. It was a bit nerve wracking to be out on my own with no safety net. Fortunately, my residency and fellowship had prepared me well.”
“While in Akron I shared an office with one of the lead surgeons, Dr. Whit Ewing, who was nearing the end of his career. He had a thriving sports medicine practice, and began sending me a lot of his patients. Working with Whit was almost like a mini fellowship; if I wasn’t busy, I would go into his OR, watch him operate, and pick his brain.”
Three years later Dr. Saluan found himself working with those who had undergone the same rigorous residency program as he had. “We moved to Cleveland in 2002, and I joined a private group, Southwest Orthopedics Inc., which claimed three former Cleveland Clinic residents. For five years I worked there, as well as the Metro Health Medical Center, where I worked alongside Dr. Dan Cooperman, an insightful pediatric orthopedist. He is a very intelligent, giving person who taught me to respect the natural history of musculoskeletal disorders in children.”
Then Cleveland Clinic sent out a search party for Dr. Saluan. “Nearly three years ago a group of surgeons, including Dr. Joe Iannotti, the Chair of orthopedics at the time, recruited me back to Cleveland Clinic. They were in need of someone to further develop their pediatric and adolescent sports program within the sports health department.”
Too smart to reinvent the wheel, Dr. Saluan crafted his vision for a pediatric and adolescent sports medicine program in part from the brilliant work of another physician.
“One of our star orthopedists, Dr. John Bergfeld, had created an exceptional program for Cleveland Clinic sports patients, so I applied what I had learned about the program while in residency with the most successful Children’s Hospital sports programs across the nation. We followed a tried and true approach to program building, i.e., first developing clinical expertise, then launching programmatic research specifically focused on the pediatric and adolescent athlete.”
Developing Research Tools
When the opportunity arose to apply for a grant from the Orthopaedic Research and Education Foundation and the Pediatric Orthopaedic Society of North America (POSNA), Dr. Saluan and colleagues leapt at the chance. “We were awarded the funding, which has allowed us to develop a musculoskeletal questionnaire that will be used with 11-18 year olds who have pain or injury in their extremities. It will provide practical, real time information that will be used in the clinic; then it can be uploaded and made part of the patient record.”
Elaborating on the utility of this tool, Dr. Saluan says, “Most outcomes instruments are not widespread and none have the clinical relevance that we are looking to create. And most of them are proxy reported, meaning that parents provide the information, something that decreases the reliability of the answers. If you have a 17-year-old with a dislocated shoulder…you would ask him certain questions such as, what type of situation led to this, how often does it happen, etc. Some of these would be included in a normal exam anyway, so our instrument provides information for research and clinical purposes. It’s not a research tool that gets in the way of clinical care—it helps facilitate care and helps you meet requirements for billing because the documentation is improved.”
He is also hoping that his clinical research will change things in the OR. “I am studying the biomechanics of different ACL reconstructions in the skeletally immature (those with open growth plates). A reconstruction may create problems with the growth plates; with different types of reconstructions, the grafts end up in slightly different positions. My theory is that these reconstructions have different biomechanical effects on the knee…you just don’t have as much rotational control with certain types of reconstructions. If I can prove my theory, the next step is to show the clinical relevance of the difference in biomechanics, something that could change the way we approach kids surgically.”
“Specifically, ” says Dr. Saluan,
it may change the timing of surgery. Prior to several years ago we used to show benign neglect with regard to when the child had surgery. When we do an ACL reconstruction, we drill across the growth plates in order to put the ACL in right, which unfortunately can lead to growth disturbances. In the past we would brace the patients, send them to physical therapy, advise them to modify their activities, and wait until the growth plates closed down. However, in the last five years we have realized that waiting was not as benign as once thought.
Sitting astride two specialties, Dr. Saluan plans to set the stage for others to share his vision. “There is such a paucity of people who specialize in both pediatric orthopaedic surgery and sports medicine. I have it as part of my five year plan to develop a pediatric and adolescent sports medicine fellowship program here at Cleveland Clinic. The clinical volume is here, and there are a substantial number of high school, college and professional teams in Northeastern Ohio.”
Given their activity level, Dr. Saluan’s family is certainly blessed to have a peds/sports medicine specialist around. “My wife and I have three children, a 14 year old daughter, an 11-year-old son and a 4-year-old daughter. Our elder daughter plays soccer and volleyball, our son plays baseball and soccer, and they are all in a ski club. My hobbies are largely work, work, work…and chasing after the kids. I do some fitness training, yard work and fixing up around the house, and I do get to the slopes with my wife and the kids.”
