How often do pitchers successfully return from Tommy John surgery?

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SUMMARIES OF STUDIES
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
David W. Altchek
Neal ElAttrache
Stan Conte
Grant H. Garcia
Joseph N. Liu
Joshua S. Dines
PUBLISHED
2016 in Journal of Shoulder and Elbow Surgery
High quality source
2
AUTHORS
Joshua Dines
David Altchek
Neal ElAttrache
Stan Conte
Grant Garcia
Joseph Liu
PUBLISHED
2016 in Arthroscopy: The Journal of Arthroscopic & Related Surgery
High quality 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
Christopher S. Ahmad
Michael E. Steinhaus
Ekene O. Nwosu
Randall W. Lee
Eric C. Makhni
PUBLISHED
2015 in The Physician and Sportsmedicine
UNRANKED SOURCE
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
Geoffrey D. Abrams
Bernard R. Bach
Charles Bush-Joseph
Joshua D. Harris
Anil K. Gupta
Brandon J. Erickson et al
PUBLISHED
2014 in The American Journal of Sports Medicine
High quality 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
Christopher S. Ahmad
Prakash Gorroochurn
Anthony P. Gualtieri
Zachary S. Morrow
Randall W. Lee
Eric C. Makhni
PUBLISHED
2014 in The American Journal of Sports Medicine
High quality source
6
AUTHORS
Charles A. Bush-Joseph
Angielyn San Juan
Anil Gupta
Joshua D. Harris
Brandon J. Erickson
Anthony A. Romeo et al
PUBLISHED
2014 in The American Journal of Sports Medicine
High quality 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
Geoffrey D. Abrams
Angielyn San Juan
Bernard R. Bach
Joshua David Harris
Brandon J. Erickson
Anil Kumar Gupta et al
PUBLISHED
2014 in Orthopaedic Journal of Sports Medicine
High quality source
8
AUTHORS
Christopher S. Ahmad
Eric C. Makhni
PUBLISHED
2014 in The American Journal of Sports Medicine
High quality source
9
AUTHORS
James L. Cook
Aaron D. Gray
PUBLISHED
2014 in The American Journal of Sports Medicine
High quality source
10
AUTHORS
Christopher S. Ahmad
Eric C. Makhni
PUBLISHED
2014 in The American Journal of Sports Medicine
High quality source
11
AUTHOR
Charles Jobin
PUBLISHED
2013 in JBJS Orthopaedic Highlights: Shoulder & Elbow
UNRANKED SOURCE
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
Anil K. Gupta
Anthony A. Romeo
Charles A. Bush-Joseph
Mark A. Jordan
Jonathan M. Frank
Joshua D. Harris et al
PUBLISHED
2013 in Sports Health: A Multidisciplinary Approach
UNRANKED SOURCE
Literature Review







ADDITIONAL STUDIES TO CONSIDER ADDING TO LIST
Total additional studies: 14
State of K's algorithms generated the list of studies below based on the studies that were added to the above list. Some of these studies may also examine: "How often do pitchers successfully return from Tommy John surgery?" If a study examines this question, add it to the list by pressing the button.

Only add studies that examine the same question. Do not add studies that are merely on the same topic.

Highly regarded source
Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers
"Background: Ulnar collateral ligament reconstruction is commonly performed in major league pitchers, but little is known about pitching performance after a return to major league play.

Hypothesis: Pitching performance after ulnar collateral ligament reconstruction returns to baseline by the second season after surgery.

Study Design: Cohort study (prognosis); Level of evidence, 2.

Methods: Data were reviewed for 68 major league pitchers who pitched in at least 1 major league game before undergoing ulnar collateral ligament reconstruction between 1998 and 2003. Mean innings pitched per season, earned run average, and walks and hits per inning pitched were compared for each major league pitcher before and after surgery. All demographic and performance variables were analyzed for an association with ulnar collateral ligament insufficiency and a successful return to major league play.

Results: Fifty-six (82%) pitchers returned to major league play at a mean of 18.5 months after surgery with no significant change in mean earned run average or walks and hits per inning pitched. The mean innings pitched per season was not statistically different from controls by the second season after surgery. Starting pitchers demonstrated a higher risk of ulnar collateral ligament injury requiring reconstruction. More experienced pitchers and those with a higher earned run average were less likely to require ulnar collateral ligament reconstruction. No factors predictive of a successful return to play were identified.

Conclusion: Most major league pitchers return from ulnar collateral ligament reconstruction by the second season after surgery with no statistical change in mean innings pitched, earned run average, or walks and hits per inning pitched from preinjury levels.

"
AUTHORS
Brian J. Sennett
G. Russell Huffman
David Webner
Brett W. Gibson
PUBLISHED
2007 in The American Journal of Sports Medicine

Add to List
Public Perceptions of Tommy John Surgery
"Background: Reconstruction of the elbow ulnar collateral ligament, known as Tommy John surgery, is being performed with increasing frequency.

Hypothesis: We hypothesized that the public's perception of Tommy John surgery may be incorrect with regard to the indications, operative technique, risks, recovery time, and benefits obtained from the procedure.

Methods: A questionnaire was developed to measure an individual's perception of Tommy John surgery with regard to indications, operative technique, risks, recovery time, and overall benefits of the procedure. Questionnaires were given via a one-on-one interview or mailing after receiving prior consent. Questionnaires were completed by 189 players, 15 coaches, and 31 parents. Data were calculated and statistical analysis was performed.

Results: None

Indications: Thirty percent of coaches, 37% of parents, 51% of high school athletes, and 26% of collegiate athletes believed that Tommy John surgery should be performed on players without elbow injury to enhance performance.

Risk Factors: Thirty-one percent of coaches, 28% of players, and 25% of parents did not believe number of pitches thrown to be a risk factor, and 38% of coaches, 29% of players, and 25% of parents did not relate pitch type (eg, curve balls) with risk of injury.

Benefits: Many players (28%) and coaches (20%) believed that performance would be enhanced beyond pre-injury level. Return to Play: Individuals underestimated the time required to return to competition. Twenty-four percent of players, 20% of coaches, and 44% of parents believed that return would occur in < 9 months.

Conclusion: This study is the first of its kind to investigate public perception of Tommy John surgery and has identified an alarming percent of players, coaches, and parents with misperceptions. Efforts should be made in our communities to better educate players, coaches, and parents regarding elbow ulnar collateral ligament injury in youth baseball players.

"
AUTHORS
R. Michael Greiwe
W. Jeffrey Grantham
Christopher S. Ahmad
PUBLISHED
2012 in The Physician and Sportsmedicine

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Glenoid labral repair in major league baseball pitchers
"Little is known about outcomes of glenoid labral repair in Major League Baseball (MLB) pitchers. We hypothesized that following repair, pitching performance would not be significantly different from an uninjured cohort. Fifty-one pitchers were identified who pitched in at least one MLB game prior to undergoing isolated glenoid labral repair. For the three years prior to and following surgery, demographic and performance variables were analyzed for an association with labral injury and repair, and compared to a control cohort of MLB pitchers without history of repair. Following surgery, 72.5% of pitchers returned to MLB at a mean of 13.1 months with no significant change in performance. Starting pitchers had a higher risk of labral injury requiring repair (p< or =0.05). Pitchers that returned to play averaged more innings pitched in the seasons prior to surgery and had a higher body mass index than those that did not return to play (p< or =0.05). Approximately 70% of MLB pitchers undergoing labral repair can be expected to return to competition postoperatively with no significant change in performance. Starting pitchers are more likely to undergo repair, but pitchers with greater preoperative innings pitched per season have a greater likelihood of returning to play."
AUTHORS
G. R. Huffman
B. J. Sennett
J. T R Lawrence
Z. Weidner
E. T. Ricchetti
PUBLISHED
in International Journal of Sports Medicine

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Glenoid Labral Repair in Major League Baseball Pitchers
"Little is known about outcomes of glenoid labral repair in Major League Baseball (MLB) pitchers. We hypothesized that following repair, pitching performance would not be significantly different from an uninjured cohort. Fifty-one pitchers were identified who pitched in at least one MLB game prior to undergoing isolated glenoid labral repair. For the three years prior to and following surgery, demographic and performance variables were analyzed for an association with labral injury and repair, and compared to a control cohort of MLB pitchers without history of repair. Following surgery, 72.5% of pitchers returned to MLB at a mean of 13.1 months with no significant change in performance. Starting pitchers had a higher risk of labral injury requiring repair (p< or =0.05). Pitchers that returned to play averaged more innings pitched in the seasons prior to surgery and had a higher body mass index than those that did not return to play (p< or =0.05). Approximately 70% of MLB pitchers undergoing labral repair can be expected to return to competition postoperatively with no significant change in performance. Starting pitchers are more likely to undergo repair, but pitchers with greater preoperative innings pitched per season have a greater likelihood of returning to play."
AUTHORS
G. R. Huffman
B. J. Sennett
Z. Weidner
E. T. Ricchetti
J. T. R. Lawrence
PUBLISHED
2010 in International Journal of Sports Medicine

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Highly regarded source
Pitching Performance and Longevity After Revision Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers
"Background:Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on professional pitchers in Major League Baseball (MLB). Although a great deal is known about primary reconstruction, much less is known about revision reconstruction.Purpose/Hypothesis:The purpose of this study was to evaluate statistical performance, return to play, and career longevity in MLB pitchers after revision UCL surgery, with the hypothesis that pitching performance and career longevity will decline after revision surgery.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 33 MLB pitchers who underwent revision UCL reconstruction surgery (UCL-R group) were identified and compared with 33 age- and position-matched controls (CTL group). Return to play, total years played, and statistical performance were evaluated and compared with controls.Results:After revision surgery, 65.5% of UCL-R pitchers returned to the MLB level. On average, the UCL-R pitchers played 0.8 years less in the major..."
AUTHORS
Nathan E. Marshall
V. Moutzouros
M. J. Bey
J. R. Lynch
R. A. Keller
N. E. Marshall et al
PUBLISHED
in The American Journal of Sports Medicine

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Return to pitching after Tommy John surgery: Response
AUTHORS
Charles A. Bush-Joseph
Angielyn San Juan
Anil Gupta
Joshua D. Harris
Brandon J. Erickson
Anthony A. Romeo et al
PUBLISHED
in American Journal of Sports Medicine

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Highly regarded source
Return To Pitching After Tommy John Surgery: Response
AUTHORS
Eric C. Makhni
Christopher S. Ahmad
PUBLISHED
in The American Journal of Sports Medicine

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Highly regarded source
Performance, Return To Competition, and Reinjury After Tommy John Surgery in Major League Baseball Pitchersa Review of 147 Cases
AUTHORS
Zachary S. Morrow
Prakash Gorroochurn
Randall W. Lee
Anthony P. Gualtieri
Eric C. Makhni
Christopher S. Ahmad
PUBLISHED
in The American Journal of Sports Medicine

Add to List
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. STUDY DESIGN: 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
Geoffrey D. Abrams
Bernard R. Bach
Charles Bush-Joseph
Joshua D. Harris
Anil K. Gupta
Brandon J. Erickson et al
PUBLISHED
in American Journal of Sports Medicine

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Performance and return-to-sport after Tommy John surgery in major league baseball pitchers
"© The Author(s) 2014.Objectives: 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
Angielyn San Juan
Geoffrey D. Abrams
Bernard R. Bach
Joshua David Harris
Brandon J. Erickson
Anil Kumar Gupta et al
PUBLISHED
in Orthopaedic Journal of Sports Medicine

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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
Joshua S. Dines
David W. Altchek
Neal ElAttrache
Stan Conte
Grant H. Garcia
Joseph N. Liu
PUBLISHED
in Journal of Shoulder and Elbow Surgery

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Performance, return to competition, and reinjury after Tommy John surgery in major league baseball pitchers: A review of 147 cases
"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\nSTUDY DESIGN: 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
Christopher S. Ahmad
Prakash Gorroochurn
Anthony P. Gualtieri
Zachary S. Morrow
Randall W. Lee
Eric C. Makhni
PUBLISHED
in American Journal of Sports Medicine

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Public perceptions of Tommy John surgery.
"BACKGROUND: Reconstruction of the elbow ulnar collateral ligament, known as Tommy John surgery, is being performed with increasing frequency.\n\nHYPOTHESIS: We hypothesized that the public's perception of Tommy John surgery may be incorrect with regard to the indications, operative technique, risks, recovery time, and benefits obtained from the procedure.\n\nMETHODS: A questionnaire was developed to measure an individual's perception of Tommy John surgery with regard to indications, operative technique, risks, recovery time, and overall benefits of the procedure. Questionnaires were given via a one-on-one interview or mailing after receiving prior consent. Questionnaires were completed by 189 players, 15 coaches, and 31 parents. Data were calculated and statistical analysis was performed.\n\nRESULTS: Indications: Thirty percent of coaches, 37% of parents, 51% of high school athletes, and 26% of collegiate athletes believed that Tommy John surgery should be performed on players without elbow injury to enhance performance. Risk Factors: Thirty-one percent of coaches, 28% of players, and 25% of parents did not believe number of pitches thrown to be a risk factor, and 38% of coaches, 29% of players, and 25% of parents did not relate pitch type (eg, curve balls) with risk of injury. Benefits: Many players (28%) and coaches (20%) believed that performance would be enhanced beyond pre-injury level. Return to Play: Individuals underestimated the time required to return to competition. Twenty-four percent of players, 20% of coaches, and 44% of parents believed that return would occur in < 9 months.\n\nCONCLUSION: This study is the first of its kind to investigate public perception of Tommy John surgery and has identified an alarming percent of players, coaches, and parents with misperceptions. Efforts should be made in our communities to better educate players, coaches, and parents regarding elbow ulnar collateral ligament injury in youth baseball players."
AUTHORS
R. Michael Greiwe
W. Jeffrey Grantham
Christopher S. Ahmad
PUBLISHED
in The Physician and Sportsmedicine

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Performance and Return-to-sport After Tommy John Surgery in Major League Baseball Pitchers
AUTHORS
Brian J. Cole
Anthony A. Romeo
Angielyn San Juan
Anil Kumar Gupta
Geoffrey D. Abrams
Bernard R. Bach et al
PUBLISHED
in Orthopaedic Journal of Sports Medicine

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