How often do pitchers successfully return from Tommy John surgery?

Submitted by: GVerdon 12

This list contains 12 studies that examine this question. The 12 studies were published from 2013 to 2016.


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Total studies in list: 12
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1
Outcomes in revision Tommy John surgery in Major League Baseball pitchers
"Background: With the recent rise in the number of Tommy John surgeries, a proportionate rise in revisions is expected. However, much is unknown regarding the current revision rate of Tommy John surgery, return to play, and change in performance in Major League Baseball (MLB) pitchers.Methods: Publicly available databases were used to obtain a list of all MLB pitchers who underwent primary and revision Tommy John surgery. Pitching performance preoperatively and postoperatively for pitchers who returned to 1 or more MLB games after revision surgery was compared with controls matched for age and position.Results: Since 1999, 235 MLB pitchers have undergone Tommy John surgeries; 31 pitchers (13.2%) underwent revision surgery, and 37% underwent revision within 3 years of the index procedure. Twenty-six revisions had more than 2 years of follow-up; 17 pitchers (65.4%) returned to pitch at least 1 major league game, whereas only 11 (42.3%) returned to pitch 10 or more games. Of those who returned to MLB competition, the average length of recovery was 20.76 months. Compared with controls matched for age and position, MLB pitchers undergoing revision surgery had a statistically shorter career after revision surgery (4.9 vs 2.6 seasons, P =.002), pitched fewer innings, and had fewer total pitches per season.Conclusions: The rate of revision Tommy John surgery is substantially higher than previously reported. For MLB pitchers, return to play after revision surgery is much lower than after primary reconstruction. The overall durability of MLB pitchers after revision ulnar collateral ligament reconstruction decreases significantly compared with controls matched for age and matched controls."
AUTHORS
Joseph N. Liu
Grant H. Garcia
Stan Conte
Neal ElAttrache
David W. Altchek
Joshua S. Dines
PUBLISHED
2016 in Journal of Shoulder and Elbow Surgery
SUBMITTED BY
JAloni 105
NO INFO ON SOURCE QUALITY
NO INFO ON SOURCE QUALITY
2
AUTHORS
Joseph Liu
Grant Garcia
Stan Conte
Neal ElAttrache
David Altchek
Joshua Dines
PUBLISHED
2016 in Arthroscopy: The Journal of Arthroscopic & Related Surgery
SUBMITTED BY
JAloni 105
HIGHLY REGARDED SOURCE
HIGHLY REGARDED SOURCE
3
Return to competition, re-injury, and impact on performance of preseason shoulder injuries in Major League Baseball pitchers
"OBJECTIVE: Major league baseball (MLB) pitchers are vulnerable to overuse injury of the upper extremity, especially in the shoulder. Injuries sustained in the preseason may have negative impact on performance following return. The goal of this study was to document the frequency of preseason shoulder injury in these athletes, as well as risk for re-injury and impact on performance following return from injury.METHODS: A comprehensive search of MLB injury information from 2001 to 2010 of public databases yielded a cohort of MLB pitchers who sustained preseason shoulder injuries. These databases were utilized to obtain information regarding return to MLB competition, re-injury, and performance following return from injury. All performance metrics were compared to those of an age-matched control cohort.RESULTS: A total of 74 pitchers were identified who sustained a preseason shoulder injury. Only 39 (53%) returned that same season to pitch in the MLB competition. Of those that returned, nearly 50% of players were re-designated on the Disabled List during the return season. There was a decline in performance in earned run average and batting average against in the year of return. Compared to age-matched control pitchers, those with preseason shoulder injury had lower performance metrics across a number of outcomes.CONCLUSION: Preseason shoulder injury in MLB pitchers has the potential to result in high re-injury rates and decreased subsequent performance."
AUTHORS
Eric C. Makhni
Randall W. Lee
Ekene O. Nwosu
Michael E. Steinhaus
Christopher S. Ahmad
PUBLISHED
2015 in The Physician and Sportsmedicine
SUBMITTED BY
JAloni 105
NO INFO ON SOURCE QUALITY
NO INFO ON SOURCE QUALITY
4
Rate of Return to Pitching and Performance After Tommy John Surgery in Major League Baseball Pitchers
"BACKGROUND: Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on Major League Baseball (MLB) pitchers in the United States. PURPOSE: To determine (1) the rate of return to pitching (RTP) in the MLB after UCL reconstruction, (2) the RTP rate in either the MLB and minor league combined, (3) performance after RTP, and (4) the difference in the RTP rate and performance between pitchers who underwent UCL reconstruction and matched controls without UCL injuries. STUDYDESIGN: Cohort study; Level of evidence, 3.METHODS: Major League Baseball pitchers with symptomatic medial UCL deficiency who underwent UCL reconstruction were evaluated. All player, elbow, and surgical demographic data were analyzed. Controls matched by age, body mass index, position, handedness, and MLB experience and performance were selected from the MLB during the same years as those undergoing UCL reconstruction. An "index year" was designated for controls, analogous to the UCL reconstruction year in cases. Return to pitching and performance measures in the MLB were compared between cases and controls. Student t tests were performed for analysis of within-group and between-group variables, respectively.RESULTS: A total of 179 pitchers with UCL tears who underwent reconstruction met the inclusion criteria and were analyzed. Of these, 148 pitchers (83%) were able to RTP in the MLB, and 174 pitchers were able to RTP in the MLB and minor league combined (97.2%), while only 5 pitchers (2.8%) were never able to RTP in either the MLB or minor league. Pitchers returned to the MLB at a mean 20.5 ± 9.72 months after UCL reconstruction. The length of career in the MLB after UCL reconstruction was 3.9 ± 2.84 years, although 56 of these patients were still currently actively pitching in the MLB at the start of the 2013 season. The revision rate was 3.9%. In the year before UCL reconstruction, pitching performance declined significantly in the cases versus controls in the number of innings pitched, games played, and wins and the winning percentage (P < .05). After surgery, pitchers showed significantly improved performance versus before surgery (fewer losses, a lower losing percentage, lower earned run average [ERA], threw fewer walks, and allowed fewer hits, runs, and home runs) (P < .05). Comparisons between cases and controls for the time frame after UCL reconstruction (cases) or the index year (controls) demonstrated that cases had significantly (P < .05) fewer losses per season and a lower losing percentage. In addition, cases had a significantly lower ERA and allowed fewer walks and hits per inning pitched.CONCLUSION: There is a high rate of RTP in professional baseball after UCL reconstruction. Performance declined before surgery and improved after surgery. When compared with demographic-matched controls, patients who underwent UCL reconstruction had better results in multiple performance measures. Reconstruction of the UCL allows for a predictable and successful return to the MLB."
AUTHORS
Charles Bush-Joseph
Bernard R. Bach
Geoffrey D. Abrams
Angielyn M. San Juan
Brian J. Cole
Anthony A. Romeo et al
PUBLISHED
2014 in The American Journal of Sports Medicine
SUBMITTED BY
JAloni 105
HIGHLY REGARDED SOURCE
HIGHLY REGARDED SOURCE
5
Performance, Return to Competition, and Reinjury After Tommy John Surgery in Major League Baseball Pitchers
"BACKGROUND: Pitching performance metrics, durability, and reinjury after Tommy John surgery in professional baseball players have not been well described.\n\nPURPOSE: The purpose of this study was to determine the likelihood of return to professional competition, reinjury rate, and change in performance after Tommy John surgery in Major League Baseball pitchers. The hypothesis was that performance metrics and durability will decline after surgery.\n\nSTUDYDESIGN: Cohort study; Level of evidence, 3.\n\nMETHODS: Publicly available records were accessed to generate a list of all Major League Baseball pitchers from 1999 to 2011 who had undergone ulnar collateral ligament reconstruction at any point in their careers; those with multiple reconstructive procedures were excluded. Return to active (≥1 game) or established (≥10 games) competition and/or placement on the disabled list was documented for each player. Among established players, pitching performance was compared pre- and postoperatively, as well as with age-matched control pitchers.\n\nRESULTS: Of 147 pitchers included, 80% returned to pitch in at least 1 Major League Baseball game. Only 67% of established pitchers returned to the same level of competition postoperatively, and 57% of established players returned to the disabled list because of injuries to the throwing arm. Finally, performance declined across several metrics after surgery compared with preinjury levels, such as earned run average, batting average against, walks plus hits per inning pitched, percentage of pitches thrown in the strike zone, innings pitched, percentage fastballs thrown, and average fastball velocity (P < .05 for all). However, these declines were not statistically different from similar declines found in age-matched controls who did not undergo Tommy John surgery.\n\nCONCLUSION: Return to the disabled list after Tommy John surgery is common among professional pitchers (>50%), and performance declines across several major metrics after surgery. Patients undergoing Tommy John surgery should be counseled appropriately regarding the likelihood of return to preinjury levels of competition and performance."
AUTHORS
Eric C. Makhni
Randall W. Lee
Zachary S. Morrow
Anthony P. Gualtieri
Prakash Gorroochurn
Christopher S. Ahmad
PUBLISHED
2014 in The American Journal of Sports Medicine
SUBMITTED BY
JAloni 105
HIGHLY REGARDED SOURCE
HIGHLY REGARDED SOURCE
6
AUTHORS
Joshua D. Harris
Anil Gupta
Angielyn San Juan
Charles A. Bush-Joseph
Brian J. Cole
Bernard R. Bach et al
PUBLISHED
2014 in The American Journal of Sports Medicine
SUBMITTED BY
JAloni 105
HIGHLY REGARDED SOURCE
HIGHLY REGARDED SOURCE
7
Performance and Return-to-Sport after Tommy John Surgery in Major League Baseball Pitchers
"© The Author(s) 2014Objectives: Ulnar collateral ligament reconstruction (UCLR) is a common procedure performed in Major League Baseball (MLB) pitchers with symptomatic UCL deficiencies. The purpose of this study was to determine: 1) the rate of return to pitching in the MLB following UCLR, 2) performance after return to pitching, and 3) the difference in return to pitching and performance between pitchers who underwent UCLR and matched controls who did not.Methods: MLB pitchers with symptomatic UCL deficiency that underwent UCLR between 1986 and 2012 were evaluated. Players’ data was extracted from MLB team websites, injury reports, player profiles/biographies, press releases and cross-referenced with the MLB injury database (MLB411). All player, elbow, and surgical demographic data were analyzed. Age, body mass index (BMI), position, handedness, and MLB experience-matched controls were selected from the MLB during the same years as those undergoing UCLR. An "index year" was designated for controls, analogous to UCLR year in cases. Return to pitching and performance measures in MLB was compared between cases and controls. Student’s t-tests were performed for analysis of within-group and between-group variables, respectively.Results: One hundred forty-eight pitchers (83%) were able to return to pitching in MLB. Length of career in MLB following UCLR was 3.9 +/- 2.84 years. Revision rate was 3.9%. In the year prior to UCLR (or index year in controls), cases were significantly (p<0.05) worse than controls with regard to number of innings pitched, games played, wins, and winning percentage and were not significantly different than controls in all remaining parameters. Pitchers undergoing UCLR had significantly (p<0.05) fewer losses, a lower losing percentage, and lower earned run average (ERA) following surgery (versus pre-surgery). In addition, cases threw significantly (p<0.05) fewer walks and allowed fewer hits, runs, and home runs following surgery. Comparisons between cases and controls for the timeframe following UCLR (cases) or index year (controls) demonstrated that cases had significantly (p<0.05) fewer losses per season and a lower losing percentage. In addition, cases had a significantly lower ERA and fewer walks and hits allowed per inning pitched (WHIP) (Table 1).Conclusion: There is a high rate of return to pitching in the MLB following UCLR. Performance declined prior to surgery and improved following surgery. When comparing to demographic-matched controls, UCLR had better results in multiple performance measures. Ulnar collateral ligament reconstruction allows for a predictable and successful return to professional-level baseball."
AUTHORS
Bernard R. Bach
Geoffrey D. Abrams
Angielyn San Juan
Brian J. Cole
Charles A. Bush-Joseph
Anthony A. Romeo et al
PUBLISHED
2014 in Orthopaedic Journal of Sports Medicine
SUBMITTED BY
JAloni 105
NO INFO ON SOURCE QUALITY
NO INFO ON SOURCE QUALITY
8
AUTHORS
Eric C. Makhni
Christopher S. Ahmad
PUBLISHED
2014 in The American Journal of Sports Medicine
SUBMITTED BY
JAloni 105
HIGHLY REGARDED SOURCE
HIGHLY REGARDED SOURCE
9
AUTHORS
Aaron D. Gray
James L. Cook
PUBLISHED
2014 in The American Journal of Sports Medicine
SUBMITTED BY
JAloni 105
HIGHLY REGARDED SOURCE
HIGHLY REGARDED SOURCE
10
AUTHORS
Eric C. Makhni
Christopher S. Ahmad
PUBLISHED
2014 in The American Journal of Sports Medicine
SUBMITTED BY
JAloni 105
HIGHLY REGARDED SOURCE
HIGHLY REGARDED SOURCE
11
AUTHOR
Charles Jobin
PUBLISHED
2013 in JBJS Orthopaedic Highlights: Shoulder & Elbow
SUBMITTED BY
JAloni 105
NO INFO ON SOURCE QUALITY
NO INFO ON SOURCE QUALITY
12
Return to Sport Following Shoulder Surgery in the Elite Pitcher
"CONTEXT: The ability to return to elite pitching, performance, and clinical outcomes of shoulder surgery in elite baseball pitchers are not definitively established.\n\nOBJECTIVE: To determine (1) the rate of return to sport (RTS) in elite pitchers following shoulder surgery, (2) postoperative clinical outcomes upon RTS, and (3) performance upon RTS and to compare RTS rates in different types of shoulder surgery.\n\nDATA SOURCES: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist, Medline, SciVerse Scopus, SportDiscus, and Cochrane Central Register of Controlled Trials were searched.\n\nSTUDY SELECTION: Levels I-IV evidence were eligible for inclusion if performance-based (eg, RTS) and/or clinical outcome-based reporting of outcomes were reported following surgical treatment of shoulder pathology in elite pitchers (major or minor league or collegiate).\n\nDATA EXTRACTION: Subject, shoulder, and pre- and postoperative performance-based variables of interest were extracted. All shoulder surgery types were potentially inclusive (eg, open, arthroscopic, rotator cuff, labrum, biceps, acromioclavicular joint, fracture). Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS).\n\nRESULTS: Six studies were analyzed (287 elite male pitchers [mean age, 27 years] who underwent shoulder surgery, with 99% on the dominant, throwing shoulder). MCMS was 38 (poor). Most pitchers were professional, with a mean career length of 6.58 years and postoperative clinical follow-up of 3.62 years. In 5 of 6 studies, multiple diagnoses were addressed concomitantly at surgery. Rate of RTS was 68% at mean 12 months following surgery. Twenty-two percent of Major League Baseball (MLB) pitchers never RTS in MLB. Overall performance did improve following surgery; however, this did not improve to pre-injury levels.\n\nCONCLUSION: In this systematic review, the rate of return to elite baseball pitching following surgery was established. Performance tended to decrease prior to surgery and gradually improve postoperatively, though not reaching pre-injury levels of pitching.\n\nLEVEL OF EVIDENCE: IV (systematic review of studies level I-IV evidence), therapeutic."
AUTHORS
Charles A. Bush-Joseph
Anthony A. Romeo
Anil K. Gupta
Geoffrey D. Abrams
Frank M. McCormick
Bernard R. Bach Jr. et al
PUBLISHED
2013 in Sports Health: A Multidisciplinary Approach
SUBMITTED BY
JAloni 105
LITERATURE REVIEW
LITERATURE REVIEW







ADDITIONAL STUDIES TO CONSIDER ADDING TO LIST
Total additional studies: 2
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Highly regarded source
Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers
You can view the abstract at: https://doi.org/10.1177/0363546506296737
AUTHORS
Brett W. Gibson
David Webner
G. Russell Huffman
Brian J. Sennett
PUBLISHED
2007 in The American Journal of Sports Medicine

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Public Perceptions of Tommy John Surgery
You can view the abstract at: https://doi.org/10.3810/psm.2012.05.1966
AUTHORS
Christopher S. Ahmad
W. Jeffrey Grantham
R. Michael Greiwe
PUBLISHED
2012 in The Physician and Sportsmedicine

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