Major League Baseball Pitching Performance After Tommy John Surgery and the Effect of Tear Characteristics, Technique, and Graft Type

2019 ◽  
Vol 47 (3) ◽  
pp. 713-720 ◽  
Author(s):  
Nathan E. Marshall ◽  
Robert Keller ◽  
Orr Limpisvasti ◽  
Brian Schulz ◽  
Neal ElAttrache

Background: Return to play and player satisfaction have been quite high after ulnar collateral ligament reconstruction (UCLR); however, there has been little reported on how outcomes are affected by surgical technique, graft type, and tear characteristics. Purpose: To evaluate surgical techniques, graft type, and tear characteristics on Major League Baseball (MLB) performance after UCLR. Study Design: Cohort study; Level of evidence, 2. Methods: MLB pitchers who underwent primary UCLR at a single institution were included. Tear characteristics included tear location, tear grade, and acuity. Surgical technique and graft type were also collected. Pitching performance statistics, including earned run average (ERA), walks and hits per innings pitched (WHIP), innings pitched, and fastball velocity were evaluated 3 years before and after UCLR. Results: Forty-six MLB pitchers were identified as having primary UCLR. Return to play was 96%, with 82% returning to MLB play. Technique performed showed no difference in performance. As compared with pitchers with gracilis grafts, pitchers with palmaris grafts were younger ( P = .043), played longer after surgery ( P = .012), and returned to play at 100% (35 of 35) versus 82% (9 of 11, P = .010). When compared with pitchers with proximal tears, pitchers with distal tears pitched at higher velocity (93.0 vs 90.6 mph, P = .023) and had better performance before surgery (ERA, P = .003; WHIP, P = .021); however, those with proximal tears improved to match this performance and velocity after reconstruction. As compared with those having partial tears, pitchers with complete tears played longer after surgery (5.9 vs 4.0 years, P = .033), had a better ERA before injury ( P = .041), and had better WHIP ( P = .037) and strikeouts per 9 innings ( P = .025) after reconstruction. Pitchers with chronic tears had a significant improvement in postoperative ERA, from 4.49 to 3.80 ( P = .040). Conclusion: Technique performed and graft type used did not affect performance; however, pitchers with palmaris grafts returned at a higher rate than those with gracilis grafts. Distal tears occurred in pitchers with greater velocity and better performance before injury, yet pitchers with proximal tears matched this performance after reconstruction. Pitchers with complete tears played longer after reconstruction. Pitchers who had partial tears had worse performance before injury and after reconstruction, and those with chronic tears saw a significant improvement in ERA with reconstruction.

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096853
Author(s):  
Braden McKnight ◽  
Nathanael D. Heckmann ◽  
Xiao T. Chen ◽  
Kevork Hindoyan ◽  
J. Ryan Hill ◽  
...  

Background: Ulnar collateral ligament (UCL) reconstruction is frequently performed on Major League Baseball (MLB) pitchers. Previous studies have investigated the effects of UCL reconstruction on fastball and curveball velocity, but no study to date has evaluated its effect on fastball accuracy or curveball movement among MLB pitchers. Purpose/Hypothesis: The primary purpose of this study was to determine the effects of UCL reconstruction on fastball accuracy, fastball velocity, and curveball movement in MLB pitchers. Our hypothesis was that MLB pitchers who underwent UCL reconstruction would return to their presurgery fastball velocity, fastball accuracy, and curveball movement. The secondary purpose of this study was to determine which factors, if any, were predictive of poor performance after UCL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: MLB pitchers who underwent UCL reconstruction surgery between 2011 and 2012 were identified. Performance data including fastball velocity, fastball accuracy, and curveball movement were evaluated 1 year preoperatively and up to 3 years of play postoperatively. A repeated-measures analysis of variance with a Tukey-Kramer post hoc test was used to determine statistically significant changes in performance over time. Characteristic factors and presurgery performance statistics were compared between poor performers (>20% decrease in fastball accuracy) and non—poor performers. Results: We identified 56 pitchers with a total of 230,995 individual pitches for this study. After exclusion for lack of return to play (n = 14) and revision surgery (n = 3), 39 pitchers were included in the final analysis. The mean presurgery fastball pitch-to-target distance was 32.9 cm. There was a statistically significant decrease in fastball accuracy after reconstruction, which was present up to 3 years postoperatively ( P = .007). The mean presurgery fastball velocity of 91.82 mph did not significantly change after surgery ( P = .194). The mean presurgery curveball movement of 34.49 cm vertically and 5.89 cm horizontally also did not change significantly ( P = .937 and .161, respectively). Conclusion: Fastball accuracy among MLB pitchers significantly decreased after UCL reconstruction for up to 3 years postoperatively. There were no statistically significant differences in characteristic factors or presurgery performance statistics between poor and non--poor performers.


2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0031
Author(s):  
Nathan E. Marshall ◽  
Robert A. Keller ◽  
Orr Limpisvasti ◽  
Brian M. Schulz ◽  
Neal S. ElAttrache

Objectives: Return to play and player satisfaction has been quite high after ulnar collateral ligament reconstruction (UCLR), however, there has been little reported on how outcomes are affected by surgical technique, graft type and tear characteristics. The purpose was to evaluate surgical techniques, graft type and tear characteristics on MLB performance after UCLR. Methods: MLB pitchers that underwent primary UCLR at a single institution were included. Tear characteristics included tear location, tear grade and acuity. Surgical technique and graft type was also collected. Pitching performance statistics, including earned run average (ERA), Walks hits per innings pitched (WHIP), innings pitched, and fastball velocity were evaluated 3 years pre- and post-UCLR. Results: 46 MLB pitchers were identified having primary UCLR. Return to play was 96%, with 82% returning to MLB play. Technique performed showed no difference in performance. Pitchers with palmaris grafts were younger (p=0.043), played longer after surgery (p=0.007), and returned to play at 100% (35/35) vs. 82% (9/11) of gracilis grafts (p=0.011). Pitchers with distal tears pitched at higher velocity (93.0 vs. 90.6 mph)(p=0.023) and had better performance (ERA, p=0.003; WHIP, p=0.003) prior to surgery, with proximal tears improving to match this performance and velocity after reconstructionhigher . Pitchers with complete tears played longer after surgery (5.9 vs. 4.0 years)(p=0.033), had better ERA (p=0.041) prior to injury and better WHIP (p=0.037) and strikeouts/9 innings (p=0.025) after reconstruction vs. partial tears. Chronic tears had a significant improvement in ERA from 4.49 to 3.80 (p=0.040) postoperatively. Conclusion: Technique performed and graft type used did not affect performance, however, palmaris grafts returned at a higher rate than gracilis grafts. Distal tears occurred in pitchers with greater velocity and better performance prior to injury with proximal tears matching this performance after reconstruction. Pitchers with complete tears played longer after reconstruction. Pitchers who had partial tears had worse performance prior to injury and after reconstruction and chronic tears saw a significant improvement in ERA with reconstruction.


2021 ◽  
pp. 036354652098723
Author(s):  
Gary Green ◽  
Keshia M. Pollack Porter ◽  
Anton Kvit ◽  
Stan Conte ◽  
John D’Angelo ◽  
...  

Background: An ongoing challenge in sports-related concussion (SRC) is determining full recovery. This study examines performance metrics in baseball after an SRC and provides a template for assessment of return-to-performance parameters. Purpose: To determine whether batting performance returns to baseline after an SRC. Study Design: Descriptive epidemiological study. Methods: Participants were all Major League Baseball (MLB) position players with confirmed SRCs that occurred during the 2011-2015 seasons. A retrospective review and assessment of performance metrics before and after injury were conducted as defined relative to the number of plate appearances (PAs) to yield reliable performance statistics. Seven batting metrics were considered as outcomes in longitudinal regressions: batting average, on-base percentage, slugging percentage, on-base plus slugging, bases on balls, strikeouts, and home runs. Metrics were calculated for each player 60, 30, and 14 days before their SRCs, as well as for the 14, 30, and 60 days after returning to play. Other variables controlled for included defensive position, player age at the time of SRC, number of days missed, mechanism of injury, whether the player completed a rehabilitation stint, and year in which the mild traumatic brain injury (MTBI) occurred (2011-2015). Results: A total of 77 MTBI case events occurred in MLB position players over 5 seasons. These injuries resulted in a mean 11.4 days lost to injury. For all performance metrics using 60 or 30 days before MTBI as baseline, no statistically significant differences were found in batting performance. In total, 63 events met PA criteria before injury. Varying the PA cutoff thresholds to be more inclusive or more restrictive yielded similar regression results. For the 48 events that met PA criteria before and after injury, most performance metrics showed no significant performance change after MTBI and, in some events, a slight though mostly nonsignificant performance improvement after MTBI. Conclusions: MLB position players who are medically cleared to return to play after an SRC perform at the same offensive performance levels as their preinjury statistics when an adequate number of PAs is used to compare performance before and after injury.


2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110413
Author(s):  
Ryan W. Paul ◽  
Ali Omari ◽  
Brian Fliegel ◽  
Meghan E. Bishop ◽  
Brandon J. Erickson ◽  
...  

Background: The coronavirus disease of 2019 (COVID-19) pandemic led to the suspension and shortening of the 2020 Major League Baseball (MLB) season from 162 to 60 regular season games. The effect of this disruption on injury rates, specifically injury to the ulnar collateral ligament (UCL), has not been quantified. Purpose/Hypothesis: The purpose of this study was to compare the rate of UCL reconstruction (UCLR), surgery timing, and pitching workload in MLB pitchers from before and after the COVID-19 pandemic lockdown. We hypothesized that UCLR rates relative to games played would be increased and pitching workload would be decreased in 2020 compared with previous seasons. Study Design: Cohort study; Level of evidence, 3. Methods: An extensive online search using publicly available data was conducted to identify all MLB pitchers who underwent UCLR between January 1, 2017, and December 31, 2020. Only pitchers who were competing at the MLB level when undergoing reconstruction were included. Player characteristics and surgery date, as well as career and season of surgery pitching workload, were collected for all included pitchers. All data were compared as a pooled sample (2017-2019 vs 2020). Results: A similar number of pitchers underwent UCLR during or after the 2020 regular season (n = 18) compared with the 2017-2019 seasons (n = 16, 20, and 16, respectively). However, after accounting for the decrease in games played during the 2020 regular season, an MLB pitcher was 2.9 times more likely to undergo surgery per game after the COVID-19 lockdown compared with the previous years ( P < .001). MLB pitchers who underwent surgery in 2020 threw fewer preseason innings than did pitchers who underwent surgery between 2017 and 2019 (5.98 vs 9.39; P = .001). Conclusion: MLB pitchers were almost 3 times more likely to undergo UCLR per game after the COVID-19 lockdown. A decreased preseason pitching workload because of the COVID-19 lockdown may have had an effect on per game UCLR rates.


2018 ◽  
Vol 6 (11) ◽  
pp. 232596711881000
Author(s):  
Eric E. Peterson ◽  
Patrick Handwork ◽  
Lonnie Soloff ◽  
Mark S. Schickendantz ◽  
Salvatore J. Frangiamore

Background: Ulnar collateral ligament (UCL) injuries represent one of the most common impairments to the throwing arm of professional pitchers. Return to play and postoperative performance metrics have been studied extensively, but pitch selection before and after surgery has not been evaluated. Purpose/Hypothesis: This study aimed to characterize the effects of UCL reconstruction on pitch selection in Major League Baseball (MLB) pitchers. We hypothesized that pitchers will throw fewer fastballs and a greater percentage of off-speed pitches after undergoing UCL reconstruction. Study Design: Retrospective cohort study; Level of evidence, 3. Methods: Using publicly available data, we evaluated MLB pitchers who underwent UCL reconstruction between 2003 and 2014. Pitching data were collected for the 2 seasons before UCL reconstruction as well as the first 2 seasons after reconstruction; the data consisted of the total number of pitches thrown and the percentage of fastballs, curveballs, changeups, and sliders. Repeated-measures analysis of variance was used with post hoc least significant difference pairwise t tests to evaluate for statistical significance at P < .05. Results: Overall, 87 pitchers (mean age, 28.2 ± 3.5 years) met all inclusion and exclusion criteria. There was a statistically significant difference in the total number of pitches thrown before and after surgery ( P < .01) as well as in the percentage of fastballs thrown before and after surgery ( P = .02). There was also a statistically significant increase in the use of curveballs between 1 and 2 years postoperatively (7.5% and 8.8%, respectively; P = .01). No other findings were statistically significant. Conclusion: Pitchers who underwent UCL reconstruction were shown to have a statistically significant decline in the percentage of fastballs thrown postoperatively as compared with before injury, with a compensatory trend toward an increased use of curveballs and sliders.


2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984426
Author(s):  
Prem N. Ramkumar ◽  
Sergio M. Navarro ◽  
Bryan C. Luu ◽  
Heather S. Haeberle ◽  
Jaret M. Karnuta ◽  
...  

Background: Despite the many reports of injury rates in Major League Baseball (MLB), little is known about the epidemiology or impact of prior musculoskeletal injuries and surgical procedures among players entering the MLB draft. Purpose: To determine the (1) epidemiology of all musculoskeletal injuries and surgical procedures among players entering the MLB draft, (2) impact of injury or surgery on draft rank, (3) impact of injury or surgery on availability within the first 2 years of play in the MLB, and (4) impact of injury or surgery on performance. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed 1890 medical records that were completed by MLB team physicians as preparticipation physical assessment prior to the draft from 2014 to 2018. Players were divided into 3 groups: noninjured, nonoperative, and operative. Draft status, overall draft rank, missed games, batting average, and earned run average for the first 2 seasons of MLB play were obtained for all available players. Players across all 3 groups were compared with linear, logistic, and beta regression models, controlling for age, position, injury status, and draft rank. Unadjusted differences among groups were assessed with 1-way analysis of variance. Results: Overall, 750 position players and 1140 pitchers were included, of whom 22.8% had no reported injury history; 48.8% reported injury treated nonoperatively; and 28.5% were treated operatively. The most common predraft injuries were elbow tendinitis (n = 312), ulnar collateral ligament injury (n = 212), and shoulder labral tear (n = 76). The most common predraft treatments were physical therapy (n = 922), ulnar collateral ligament reconstruction (n = 115), and fracture fixation (n = 69). Of the 1890 players, 719 were drafted and played for at least 2 years. No difference was found among noninjured, nonoperative, and operative groups in terms of draft rank, games missed, or performance. Players with a nonoperative injury had a decreased odds ratio of being drafted (0.738; P = .017). Conclusion: More than half of the players entering the MLB reported a history of musculoskeletal injury requiring treatment, and the most commonly affected joints were the shoulder and elbow. Musculoskeletal history did not affect draft rank, short-term availability, or performance for MLB prospects.


2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091302 ◽  
Author(s):  
Joshua G. Peterson ◽  
Vehniah K. Tjong ◽  
Michael A. Terry ◽  
Matthew D. Saltzman ◽  
Stephen M. Gryzlo ◽  
...  

Background: Sports-related concussions have garnered significant attention in recent years because of the negative effects they can have on a player’s cognitive health and performance. In response to this growing concern, Major League Baseball (MLB) introduced a standardized concussion protocol during the 2011-2012 season. Purpose/Hypothesis: The purpose of this study was to compare the reported incidence of concussions and the subsequent performance of MLB players before and after the introduction of the standardized concussion protocol. We hypothesized that the introduction of the standardized concussion protocol would not have an impact on player performance postconcussion. Study Design: Cohort study; Level of evidence, 3. Methods: Players who suffered a concussion between 2001 and 2018 were identified from the MLB transactions page. Incidence and player performance were compared before and after the introduction of the standardized concussion protocol. Player performance was evaluated using traditional data and sabermetric data, which are advanced statistics used in conjunction with standard statistics to better compare players and teams. Player averages were calculated and compared using paired t tests for 30 days before and after concussion, 1 year before and after concussion, and career before and after concussion. Averages were also compared before and after the institution of the standardized concussion protocol using independent-measures t tests. Results: There were a total of 114 players who suffered 142 concussions, with 77% of those occurring after the introduction of the concussion protocol (32 before, 110 after). The average time missed because of concussion significantly decreased from 33.7 days (range, 10-122 days) to 18.9 days (range, 6-111 days) after the concussion protocol ( P = .0005). There was no difference in player performance (including batting average, on-base percentage, and slugging for batters; earned run average, fielding-independent pitching, and walks plus hits per inning pitched for pitchers) after concussion at any time point (30 days, 1 year, or career) when comparing these statistics before versus after the MLB concussion protocol. However, batter performance was significantly poorer 1 year after concussion and over the remainder of the players' careers ( P < .05). Conclusion: The number of reported concussions increased after the introduction of the MLB concussion protocol. However, players spent significantly less time on the disabled list without any adverse effect on player performance. Despite these changes, long-term batting performance was significantly poorer after concussion.


2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774502 ◽  
Author(s):  
Brandon J. Erickson ◽  
Junyoung Ahn ◽  
Peter N. Chalmers ◽  
Christopher S. Ahmad ◽  
Bernard R. Bach ◽  
...  

Background: Ulnar collateral ligament reconstruction (UCLR) has become an increasingly common procedure among Major League Baseball (MLB) pitchers. The long-term effects of this procedure on the career of an MLB pitcher are largely unknown. Purpose/Hypothesis: The purpose of this study was to determine why and when MLB pitchers who underwent UCLR during their careers retired from baseball as compared with controls. We hypothesized that pitchers who underwent UCLR are no more likely than control pitchers to retire from elbow or shoulder problems. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All MLB pitchers who underwent UCLR were identified through publicly available data. A cohort of pitchers who did not undergo UCLR were matched to pitchers with a history of UCLR, based on sex, age, draft year, and draft round. Of those who were no longer pitching in the MLB, the reason for retirement was determined. Reason for retirement and length of career following UCLR (surgical group) and index year (control group) were determined and compared through prior studies via the MLB HITS database, MLB team websites, and publicly available internet-based injury reports. Results: Overall, 153 MLB pitchers who underwent UCLR between 1974 and 2015 are currently retired. Mean ± SD time to retirement was 4.4 ± 4.7 years (range, 0-26 years) after the index year in the control group and 4.4 ± 3.5 years (range, 0-15 years) after surgery in the UCLR group ( P = .388). Patients who were status post-UCLR were significantly more likely to be released during the season (34 of 144, 23.6%) than were players who were not status post-UCLR (14 of 144, 9.7%) ( P = .002). Shoulder injury as a reason for retirement was more common in the control group than the UCLR group ( P = .011). Elbow injury as a reason for retirement was not more common in either group ( P = .379). Leg injury as a reason for retirement was more common in the control group ( P = .013). Performance as a reason for retirement was more common in the UCLR group than the control group ( P < .001). Conclusion: MLB pitchers who have undergone UCLR are no more likely to retire from shoulder or elbow injuries than are those who have not undergone UCLR. MLB career length was similar between pitchers with and without a history of UCLR.


2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096631
Author(s):  
Stephen J. Thomas ◽  
Ryan W. Paul ◽  
Adam B. Rosen ◽  
Sam J. Wilkins ◽  
Joseph Scheidt ◽  
...  

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.


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