Functional outcomes following revision ulnar collateral ligament reconstruction in Major League Baseball pitchers

There is a paucity of data regarding outcomes following revision ulnar collateral ligament (UCL) reconstruction in Major League Baseball (MLB) pitchers. A single case series comprised of 4 MLB pitchers has reviewed outcomes in this cohort and reported a 75% rate of return to pitching. We hypothesize that MLB pitchers demonstrate a low rate of return to their pre-injury pitch workload following revision surgery.

Clinical outcomes were reviewed with an emphasis on return to pre-injury pitch workload. Utilizing MLB player performance statistics, the postoperative pitch workload (appearances for relief pitchers and games started/innings pitched for starting pitchers) was calculated to determine if players were able to resume pre-injury throwing activity. Position-specific analyses for pitchers (starter vs relief) were also performed utilizing objective pitching statistics.

Overall, 78% (14/18) of pitchers were able to return to MLB play within 2 full seasons. Relief pitchers were able to resume 50% of their pre-injury pitch workload, while starting pitchers only reached 35% of their prior workload (P = .52). Relievers demonstrated better pitching statistics (ERA [earned run average], K/9 [strikeouts per 9 innings], and BB/9 [walks per 9 innings]) when compared to starters. Two starting pitchers were reassigned to relief roles by their teams, resulting in improvement in their postoperative pitch workload (mean 94%).

The overall rate of return to pre-injury pitch workload following revision UCL reconstruction is low among professional pitchers. Starting pitchers may be at higher risk for treatment failure in the revision setting, given the increased demands of the position, and may benefit from reassignment to a relief role.