Elbow Arthroscopy and the Risk of Future Ulnar Collateral Ligament Surgery in Professional Baseball Pitchers

Ulnar collateral ligament (UCL) injuries have become common in professional baseball players. It is unclear if elbow arthroscopy to treat posteromedial impingement in these athletes is a precursor to UCL surgery.

The purpose of this study was to determine the outcomes, performance, and future risk of UCL surgery in professional baseball players who underwent elbow arthroscopy with debridement. It was hypothesized that players would see no significant change in performance and would have a >10% chance of future UCL surgery after elbow arthroscopy.

Case-control study; Level of evidence, 3.

All professional baseball players who underwent elbow arthroscopy for debridement between 2010 and 2023 were identified using the Major League Baseball Health and Injury Tracking System. Demographic and performance data (pre- and postsurgery) for each player were recorded. Future UCL surgery in any of these players was recorded. Performance metrics were then compared between cases and a group of matched controls.

There were 354 elbow arthroscopies in players with no history of UCL surgery, of whom 43 (12.1%) underwent UCL surgery after elbow arthroscopy (39 pitchers and 4 position players). For pitchers, the mean time to return to play was 285 ± 185 days, while the mean time to return to the same level of play was 304 ± 201 days. In 8 pitchers (21%), the UCL surgery was performed before they were able to return to play after the arthroscopy, while in 31 pitchers (79%), they returned and then underwent UCL surgery. There was a mean of 2.7 ± 2.8 years (range, 0.2-10.8 years) between arthroscopy and UCL surgery. There were no significant differences in performance data between pre- and postarthroscopy except for fewer balls batted after arthroscopy. When matched to controls, there were significantly fewer balls batted in the arthroscopy group. The risk of future UCL surgery in controls was 10%.

After elbow arthroscopy, professional baseball players saw an improvement in several performance metrics. Risk of future UCL surgery in players who underwent elbow arthroscopy was 12.1%, which was not significantly different from the risk of UCL surgery in control players who had not undergone elbow arthroscopy. Isolated elbow arthroscopy appears to be an effective treatment in professional baseball players without increasing the risk of future UCL surgery.