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

Abstract

Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) is very common in baseball. However, no review has compared the return-to-play (RTP) and in-game performance statistics of pitchers after primary and revision UCLR as well as of position players after UCLR. Purpose: To review, synthesize, and evaluate the published literature on outcomes after UCLR in baseball players to determine RTP and competitive outcomes among various populations of baseball players. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search including studies between 1980 and November 4, 2019, was conducted for articles that included the following terms: ulnar collateral ligament, elbow, medial collateral ligament, Tommy John surgery, throwing athletes, baseball pitchers, biomechanics, and performance. To be included, studies must have evaluated baseball players at any level who underwent UCLR (primary or revision) and assessed RTP and/or competitive outcomes. Results: A total of 29 studies with relatively high methodological quality met the inclusion criteria. After primary UCLR, Major League Baseball (MLB) pitchers returned to play in 80% to 97% of cases in approximately 12 months; however, return to the same level of play (RTSP) was less frequent and took longer, with 67% to 87% of MLB pitchers returning in about 15 months. RTP rates for MLB pitchers after revision UCLR were slightly lower, ranging from 77% to 85%, while RTSP rates ranged from 55% to 78%. RTP rates for catchers (59%-80%) were generally lower than RTP rates for infielders (76%) and outfielders (89%). All studies found a decrease in pitching workloads after UCLR. Fastball usage may also decrease after UCLR. Changes in earned run average and walks plus hits per inning pitched were inconclusive. Conclusion: Pitchers returned to play after UCLR in approximately 12 months and generally took longer to return to their same level of play. Pitchers also returned to play less frequently after revision UCLR. After both primary and revision UCLR, professional pitchers experienced decreased workloads and potentially decreased fastball usage as well. Catchers may RTP after UCLR less frequently than pitchers, infielders, and outfielders possibly because of the frequency of throwing in the position. These results will help guide clinical decision making and patient education when treating UCL tears in baseball players.

Psychological Factors Associated With Return to Play After Ulnar Collateral Ligament Reconstruction: A Systematic Review

“… 7 Previously established factors affecting RTP include surgical technique, graft fixation technique, level of competition, and sport and position played. 4 , 20 , 21 With the dramatic increase in the number of UCL reconstruction procedures performed annually and the expansion of UCL reconstruction candidates to include younger patient populations, 7 , 9 , 10 it is imperative to more thoroughly understand factors affecting RTP after UCL reconstruction.…”

Recommendations from the ICM-VTE: Shoulder & Elbow

“…Rationale: Controversies remain whether or not the patients undergoing ligament reconstruction surgery for elbow instability [146][147][148] should be routinely administered VTE prophylaxis.…”

Pain Is the Most Frequently Cited Reason Athletes Fail to Return to Sport After Ulnar Collateral Ligament Surgery: A Systematic Review and Meta-analysis

“…Erickson et al 18 reported on 20 studies with an 86.2% pooled RTS rate. Thomas et al 50 reported that among baseball players, return-to-play rates after UCL reconstruction varied by position. They found that catchers return to play less frequently than pitchers, infielders, or outfielders, and that pitching workloads decrease after UCL reconstruction.…”

“…They found that catchers return to play less frequently than pitchers, infielders, or outfielders, and that pitching workloads decrease after UCL reconstruction. 50 However, to the best of our knowledge, no previous systematic review has characterized the reasons for why athletes fail to RTS after UCL reconstruction.…”