Major League Baseball Pitching Performance After Tommy John Surgery and the Effect of Tear Characteristics, Technique, and Graft Type

Abstract

Background: Return to play and player satisfaction have been quite high after ulnar collateral ligament reconstruction (UCLR); however, there has been little reported on how outcomes are affected by surgical technique, graft type, and tear characteristics. Purpose: To evaluate surgical techniques, graft type, and tear characteristics on Major League Baseball (MLB) performance after UCLR. Study Design: Cohort study; Level of evidence, 2. Methods: MLB pitchers who underwent primary UCLR at a single institution were included. Tear characteristics included tear location, tear grade, and acuity. Surgical technique and graft type were also collected. Pitching performance statistics, including earned run average (ERA), walks and hits per innings pitched (WHIP), innings pitched, and fastball velocity were evaluated 3 years before and after UCLR. Results: Forty-six MLB pitchers were identified as having primary UCLR. Return to play was 96%, with 82% returning to MLB play. Technique performed showed no difference in performance. As compared with pitchers with gracilis grafts, pitchers with palmaris grafts were younger ( P = .043), played longer after surgery ( P = .012), and returned to play at 100% (35 of 35) versus 82% (9 of 11, P = .010). When compared with pitchers with proximal tears, pitchers with distal tears pitched at higher velocity (93.0 vs 90.6 mph, P = .023) and had better performance before surgery (ERA, P = .003; WHIP, P = .021); however, those with proximal tears improved to match this performance and velocity after reconstruction. As compared with those having partial tears, pitchers with complete tears played longer after surgery (5.9 vs 4.0 years, P = .033), had a better ERA before injury ( P = .041), and had better WHIP ( P = .037) and strikeouts per 9 innings ( P = .025) after reconstruction. Pitchers with chronic tears had a significant improvement in postoperative ERA, from 4.49 to 3.80 ( P = .040). Conclusion: Technique performed and graft type used did not affect performance; however, pitchers with palmaris grafts returned at a higher rate than those with gracilis grafts. Distal tears occurred in pitchers with greater velocity and better performance before injury, yet pitchers with proximal tears matched this performance after reconstruction. Pitchers with complete tears played longer after reconstruction. Pitchers who had partial tears had worse performance before injury and after reconstruction, and those with chronic tears saw a significant improvement in ERA with reconstruction.

Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes

“…Among articles reporting results for docking reconstruction, there was 1 level 2 study, 32 1 level 3 study, 2 and 8 level 4 studies. 9,15,16,23,29,30,35,38 Among articles reporting results for figure-of-8 reconstruction, there was 1 level 2 study, 32 2 level 3 studies, 2,17 and 11 level 4 studies. ‖ Three studies 2,23,32 reported results for both techniques.…”

Return-to-Play and Competitive Outcomes After Ulnar Collateral Ligament Reconstruction Among Baseball Players: A Systematic Review

“…16,22,23,25,28,34,40,41 RTSP was less frequent, with 67% to 87% of MLB pitchers returning in about 15 months. 16,22,23,25,28,34,40,41 These results do demonstrate variability in the RTP and RTSP rates. When returning to play at a professional level, several things need to be considered that could contribute to this variability: age of the pitcher, role in the organization (starter, reliever, and closer), additional injuries (bone spurs, chondral defects, valgus extension overload, etc), and comorbidities.…”

“…Catchers may also require close monitoring after UCLR, with catchers (59%-80%) 3,40 returning to play after primary UCLR less frequently than pitchers (80%-97%), 16,22,23,25,28,34,40,41 infielders (76%), 3 and outfielders (89%). 3 Catchers throw much more often than other position players and play in more games than pitchers, possibly explaining their low RTP rates.…”

“…RTP rates for MLB pitchers after primary UCLR ranged from 80% to 97% with a mean of 12 months until RTP, 16,22,23,25,28,34,41,42 while RTSP rates ranged from 67% to 87% with almost 15 months until RTP. 16,22,23,25,28,34,39,41,42 RTP rates for MLB pitchers after revision UCLR were slightly lower, ranging from 77% to 85%, 5,43 while RTSP rates ranged from 55% to 78%. 5,30,37,43 There were 3 studies 2,3,27 that analyzed RTP of MLB position players, but only Camp et al 3 had a sufficient sample size after separating the position players into infielders (n ¼ 34), outfielders (n ¼ 35), and catchers (n ¼ 24).…”

Performance in Collegiate-Level Baseball Players After Elbow Ulnar Collateral Ligament Reconstruction

“…However, the sample size is comparable with samples in prior studies on pitching performance after UCLR in MLB. 8,17,18 Despite these limitations, our investigation has several strengths: It provides homogeneity because it analyzes a single surgeon's series of UCLRs, it is one of few studies to explicitly investigate return to play in collegiate baseball players in the context of remaining eligibility, and it remains one of the first studies to analyze postoperative performance data compared with a matched cohort of control players within this age group.…”