Performance and Return to Sport After Tommy John Surgery Among Major League Baseball Position Players

Jack, Robert A.; Burn, Matthew B.; Sochacki, Kyle R.; McCulloch, Patrick C.; Lintner, David M.; Harris, Joshua D.

doi:10.1177/0363546518762397

Cited by 35 publications

(38 citation statements)

References 29 publications

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“…There has been extensive research on the reconstruction of UCL tears in elite-level and professional baseball players, with RTP rates that range from 67% to 95%. 2,5,13,20,25-28…”

Section: Discussionmentioning

confidence: 99%

“…There has been extensive research on the reconstruction of UCL tears in elite-level and professional baseball players, with RTP rates that range from 67% to 95%. 2,5,13,20,[25][26][27][28] Nonoperative treatment has been suggested for milder UCL injuries, but few studies have documented its outcome. 14,15,23,32 Rettig et al 32 showed a 42% RTP with nonoperative treatment for UCL tears in a broad spectrum of overhead throwers.…”

Section: Discussionmentioning

confidence: 99%

“…5,[10][11][12]31 Outcomes after UCL reconstruction (UCLR) in professional baseball players have been well studied, with high rates of return to play (RTP). 2,5,13,20,[25][26][27][28] However, studies of nonoperative treatment of UCL injuries have been limited to smaller subsets of players, with a wide range of RTP rates. 14,15,23,32 Rettig et al 32 showed a 42% RTP rate in the first study to evaluate nonoperative treatment of UCL tears in overhead throwers.…”

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confidence: 99%

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Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries With and Without Platelet-Rich Plasma in Professional Baseball Players: A Comparative and Matched Cohort Analysis

et al. 2019

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Background: Recent studies evaluating nonoperative treatment of elbow ulnar collateral ligament (UCL) injuries augmented with platelet-rich plasma (PRP) have shown promising results. To date, no comparative studies have been performed on professional baseball players who have undergone nonoperative treatment with or without PRP injections for UCL injuries. Hypothesis: Players who received PRP injections would have better outcomes than those who did not receive PRP. Study Design: Cohort study; Level of evidence, 3. Methods: The Major League Baseball (MLB) Health and Injury Tracking System identified 544 professional baseball players who were treated nonoperatively for elbow UCL injuries between 2011 and 2015. Of these, 133 received PRP injections (PRP group) before starting their nonoperative treatment program, and 411 did not (no-PRP group). Player outcomes and a Kaplan-Meier survival analysis were compared between groups. In addition, to reduce selection bias, a 1:1 matched comparison of the PRP group versus the no-PRP group was performed. Players were matched by age, position, throwing side, and league status: major (MLB) and minor (Minor League Baseball [MiLB]). A single radiologist with extensive experience in magnetic resonance imaging (MRI) interpretation of elbow injuries in elite athletes analyzed 243 MRI scans for which images were accessible for tear location and grade interpretation. Results: Nonoperative treatment of UCL injuries resulted in an overall 54% rate of return to play (RTP). Players who received PRP had a significantly longer delay in return to throwing ( P < .001) and RTP ( P = .012). The matched cohort analysis showed that MLB and MiLB pitchers in the no-PRP group had a significantly faster return to throwing ( P < .05) and the MiLB pitchers in the no-PRP group had a significantly faster RTP ( P = .045). The survival analysis did not reveal significant differences between groups over time. The use of PRP, MRI grade, and tear location were not statistically significant predictors for RTP or progression to surgery. Conclusion: In this retrospective matched comparison of MLB and MiLB pitchers and position players treated nonoperatively for a UCL tear, PRP did not improve RTP outcomes or ligament survivorship, although there was variability with respect to PRP preparations, injection protocols, time from injury to injection, and rehabilitation programs. MRI grade and tear location also did not significantly affect RTP outcomes or progression to surgery.

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“…There has been extensive research on the reconstruction of UCL tears in elite-level and professional baseball players, with RTP rates that range from 67% to 95%. 2,5,13,20,25-28…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries With and Without Platelet-Rich Plasma in Professional Baseball Players: A Comparative and Matched Cohort Analysis

et al. 2019

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“…Catchers, however, suffered the lowest RPP rate of 56%, with decreases in the home run rate, runs batted in, and isolated power. 2 Jack et al 17 reported no difference in RPP rates and on-field performance statistics for position players and pitchers in a retrospective series of 34 MLB players after UCL reconstruction. In the nonoperative literature, Ford et al 12 reported success in 28 MLB players with partial UCL tears and recommended the use of an MRI grading system to predict RTP and the need for surgery, which this study hoped to accomplish.…”

Section: Discussionmentioning

confidence: 95%

Clinical Utility of an MRI-Based Classification System for Operative Versus Nonoperative Management of Ulnar Collateral Ligament Tears: A 2-Year Follow-up Study

Ramkumar

Haeberle

Navarro

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: A recently introduced classification system of medial ulnar collateral ligament (UCL) tears accounting for location and severity has demonstrated high interobserver and intraobserver reliability, but little is known about its clinical utility. Purpose: The primary purpose of this study was to assess the relationship of the magnetic resonance imaging (MRI)–based classification system in predicting which athletes had success with nonoperative versus operative treatment after completing a standardized rehabilitation program. A secondary objective included return to play (RTP) and return to prior performance (RPP) analyses of baseball players. Study Design: Cohort study; Level of evidence, 3. Methods: After an a priori power analysis, 58 consecutive patients with UCL tears and a minimum of 2-year follow-up were retrospectively divided into 2 groups: those who successfully completed operative treatment and those who completed nonoperative treatment. The MRI-based classification stages accounting for UCL tear location and severity were compared between the nonoperative and operative groups. A subanalysis for baseball players, including RTP and RPP, was performed. Results: A total of 58 patients (40 baseball players [34 pitchers]) met inclusion criteria. Of these patients 35 (32 baseball players [27 pitchers]) underwent surgery, and 23 (8 baseball players [7 pitchers]) underwent nonoperative management. No patients in the nonoperative arm crossed over to surgery after completing the rehabilitation program. Patients with distal tears (odds ratio, 48.0; P = .0004) and complete tears (odds ratio, 5.4; P = .004) were more likely to undergo surgery. Baseball players, regardless of position, were confounding determinants of operative management, although there was no difference in RTP and RPP between treatment arms. Conclusion: A 6-stage MRI-based classification system addressing UCL tear location and severity may help early decision making, as patients likely to fail nonoperative treatment have complete, distal tears, whereas those with proximal, partial tears may be more amenable to nonoperative management.

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“…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.…”

Section: Limitationsmentioning

confidence: 99%

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

Swindell

Trofa

Confino

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The increase in ulnar collateral ligament (UCL) elbow reconstructions over the past 20 years has affected younger athletes more than any other age group. Although return to play and postoperative performance have been extensively studied in professional baseball players, outcomes in collegiate baseball players are less known. Purpose/Hypothesis: The purpose of this study was to characterize return to play and changes in performance after UCL reconstruction (UCLR) in collegiate baseball players. We hypothesized that collegiate baseball players would have similar return-to-play rates compared with professional athletes and no significant differences in performance compared with matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Collegiate athletes undergoing UCLR by a single surgeon were identified. Postoperatively, individual collegiate career paths were analyzed through use of publicly available data from team websites, injury reports, and press releases. Data obtained included time to return to competition, number of collegiate seasons played after surgery, total games started and played, seasonal wins, losses, saves, innings played, hits, earned run average (ERA), home runs, shutouts, strikeouts, walks, and walks plus hit per inning pitched (WHIP). The UCLR group was compared with a matched control group of collegiate pitchers without elbow injury. Results: Of the 58 collegiate baseball players analyzed (mean ± SD age, 19.95 ± 1.19 years), 84.5% returned to play at the collegiate level. Players returned to competition at 16.98 ± 6.16 months postoperatively and competed for 1.60 ± 0.84 seasons postoperatively. In terms of career longevity, 81.0% of collegiate pitchers either completed their collegiate eligibility or remained on active rosters, and 2 players (4.1%) ultimately played at the professional level after UCLR. Compared with a matched cohort, the UCLR group had no significant differences in collegiate pitching performance statistics after surgery. Conclusion: College baseball players returned to play at a rate comparable with the rate published in prior literature on professional pitchers and often completed their collegiate playing eligibility postoperatively. Compared with controls, the UCLR group had no statistically significant differences in pitching performance postoperatively. Further studies are needed to determine the exact reasons why college players retire despite having endured extensive surgical and postoperative rehabilitation processes related to UCLR. Younger populations are experiencing elbow injuries at an increasing rate secondary to increased workloads at the amateur level. As these athletes matriculate into the collegiate ranks, they are at continued risk of sustaining UCL injury, and little explicit information is available on their prospects of return to play and career longevity after UCLR.

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Performance and Return to Sport After Tommy John Surgery Among Major League Baseball Position Players

Cited by 35 publications

References 29 publications

Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries With and Without Platelet-Rich Plasma in Professional Baseball Players: A Comparative and Matched Cohort Analysis

Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries With and Without Platelet-Rich Plasma in Professional Baseball Players: A Comparative and Matched Cohort Analysis

Clinical Utility of an MRI-Based Classification System for Operative Versus Nonoperative Management of Ulnar Collateral Ligament Tears: A 2-Year Follow-up Study

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

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