scholarly journals Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985289 ◽  
Author(s):  
Brandon J. Erickson ◽  
Peter N. Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Anthony A. Romeo
Keyword(s):  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Open Reduction Internal Fixation ◽  
Medial Epicondyle ◽  
Professional Baseball ◽  
Performance Outcome ◽  
History Of ◽  
Baseball Pitchers ◽  
And Performance ◽  
And Control

Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure among professional baseball pitchers. An uncommon complication after UCLR is a fracture of the medial epicondyle at the level of the humeral tunnel, which requires open reduction internal fixation (ORIF). Purpose/Hypothesis: The purpose of this study was to determine the performance upon and rate of return to sport (RTS) in professional baseball pitchers after ORIF of the medial epicondyle and examine whether there is a difference in the RTS rate and performance between players who underwent ORIF and matched controls. It was hypothesized that there would be a high rate of RTS in professional baseball pitchers after ORIF of the medial epicondyle, with no difference between the ORIF and control groups in the rate of RTS or performance, specifically related to the primary performance outcome variables of win-loss percentage, walks plus hits per inning pitched, fielding independent pitching, and wins above replacement. Methods: All professional baseball pitchers who underwent ORIF of the medial epicondyle between 2010 and 2016 were included in this study. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between the ORIF and control (no history of UCLR or ORIF) groups. Results: Overall, 15 pitchers (80.0% starters, 73.3% right-handed) underwent ORIF of a medial epicondyle fracture. All had undergone prior UCLR using either the American Sports Medicine Institute (n = 9; 60.0%) or docking (n = 6; 40.0%) technique. ORIF techniques included fixation with 1 screw (n = 13; 86.7%) and fixation with suture anchors (n = 2; 13.3%). Eleven (73.3%) pitchers were able to return to sport (did not differ from controls; P = .537); 55% returned to the same level or higher. No significant differences existed in the primary performance outcome variables when comparing preoperative with postoperative performance. No significant differences in the primary performance outcome variables were seen between the ORIF and control groups after surgery, although players in the ORIF group pitched fewer innings than controls after surgery ( P = .003). Conclusion: After ORIF of the medial epicondyle in professional pitchers with a history of UCLR, 73.3% were able to return to sport (only 55% of those who returned pitched at the same level or higher) without a significant decline in most performance variables when compared with their preoperative performance or matched controls. The number of innings pitched declined after surgery.

scholarly journals Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0036
Author(s):  
Brandon J. Erickson ◽  
Peter Nissen Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Anthony A. Romeo
Keyword(s):  
Ulnar Collateral Ligament ◽  
Open Reduction Internal Fixation ◽  
Medial Epicondyle ◽  
Professional Baseball ◽  
Performance Outcome ◽  
Performance Variables ◽  
History Of ◽  
Operative Performance ◽  
Baseball Pitchers ◽  
And Performance

Objectives: Ulnar collateral ligament reconstruction (UCLR) is a common procedure among professional baseball pitchers. Currently, 25% of starting Major league baseball (MLB) pitchers have undergone UCLR. Fracture of the medial epicondyle at the level of the humeral tunnel requiring open reduction internal fixation (ORIF) is an uncommon complication following UCLR. The purpose of this study was to determine the rate of return to sport (RTS) and performance upon RTS in professional baseball pitchers following ORIF of the medial epicondyle, and see if there is a difference in RTS rate and performance between players who underwent ORIF and matched controls. The authors hypothesized that there is a high rate of RTS in professional baseball pitchers following medial epicondyle ORIF with no significant difference in rate of RTS or performance, specifically related to the primary outcome performance variables of win-loss percentage (W-L%), WHIP ((walks +hits)/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)) between cases and controls. Methods: All professional baseball pitchers who underwent medial epicondyle ORIF between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and matched controls (no history of UCLR or ORIF). Results: Overall, 15 pitchers (80% starters, 73.3% right-handed) underwent ORIF of a medial epicondyle fracture. All underwent a prior UCLR using either the American Sports Medicine Institute (n=9, 60%) or docking (n=6, 40%) technique. ORIF techniques included fixation with one screw (n=13, 86.7%) and fixation with suture anchors (n=2, 13.3%). Eleven (73.3%) pitchers were able to RTS (which did not differ from controls p=0.537). No significant differences existed in the primary performance outcome variables when comparing pre-operative to post-operative performance. No significant differences in the primary performance outcome measures were seen between cases and controls following surgery although cases pitched fewer innings than controls following surgery (p=0.003) Conclusion: Following medial epicondyle ORIF of professional pitchers with a history of UCLR, 73.3% were able to RTS without a significant decline in most performance variables when compared to their pre-operative performance levels, or when compared to matched controls. Number of innings pitched declined following surgery.

scholarly journals Update On Performance And Return To Sport After Biceps Tenodesis In Professional Baseball Players (226)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0033
Author(s):  
Brandon Erickson ◽  
Peter Chalmers ◽  
John Dangelo ◽  
Kevin Ma ◽  
Dana Rowe ◽  
...  
Keyword(s):  
Performance Metrics ◽  
Return To Sport ◽  
Interference Screw ◽  
Return To Play ◽  
Professional Baseball ◽  
Biceps Tenodesis ◽  
Baseball Players ◽  
Slap Repair ◽  
History Of ◽  
And Performance

Objectives: Determine the return to sport (RTS) rate and performance upon RTS in professional baseball players who underwent biceps tenodesis. Methods: All professional baseball pitchers who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between the biceps tenodesis and matched control (no history of biceps tenodeses) groups. Results: 14 players (average age 27±4 years; 12 pitchers, 2 position outfielders) were included. Most (79%) were open subpectoral tenodeses while one was an arthroscopic biceps transfer and one was arthroscopic suprapectoral. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%) and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent SLAP repair). Among the 14 players, 2 were unable to RTS, 5 RTS but to a lower level, and 7 RTS at the same or a higher level. Thus, overall, while 86% (12/14) were able to RTS, 50% (7/14) were able to return to the same or a better level and 50% were either unable to return or returned to a lower level. Among pitchers specifically, 100% (12/12) were able to return to play, but only 50% (6/12) were able to return to the same or a higher level. For those players who did return to play, it took 245±84 days, their performance was unchanged and did not differ from matched controls. Conclusions: While 86% of professional baseball players returned to sport following biceps tenodesis, only 50% returned at the same or higher level. No decline in performance was noted in players who successfully returned. Open subpectoral tenodesis is the most common tenodesis technique performed on professional baseball players.

scholarly journals Performance and Return to Sport Following Latissimus Dorsi and Teres Major Injuries in Professional Baseball Pitchers

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0014
Author(s):  
Brandon J. Erickson ◽  
Peter Nissen Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Anthony A. Romeo
Keyword(s):  
Operative Treatment ◽  
Latissimus Dorsi ◽  
Performance Metrics ◽  
Return To Sport ◽  
Professional Baseball ◽  
Performance Variables ◽  
Significant Difference ◽  
Teres Major ◽  
Baseball Pitchers ◽  
And Performance

Background: Latissimus dorsi and teres major (LD/TM) tears are becoming an increasing common cause of injury and disability amongst professional baseball pitchers. Purpose: To determine the rate of return to sport (RTS) and performance upon RTS in professional baseball pitchers following LD/TM tears treated both operatively and non-operatively, and to see if there is a difference in RTS rate and performance between players who sustained a LD/TM tear and matched controls within each treatment group. Hypothesis: There is a high rate of RTS in professional baseball pitchers following LD/TM tears with no significant difference in rate of RTS or performance, specifically related to the primary outcome performance variables of earned run average (ERA), WHIP ((walks +hits)/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)) between cases and controls for both operative and non-operative treatment. Methods: All professional baseball pitchers who sustained a LD/TM tear between 2011-2016 were included. Demographic and performance data (pre and post injury) for each player was recorded. Performance metrics were then compared between cases and matched controls within both operatively non-operative treatment. Results: Overall 120 pitchers sustained a LD/TM tear; 42 (35%) were playing at the major league level at the time of injury. The majority of players (107 (89.2%)) were treated non-operatively. The average time to return to the same level of competition for pitchers treated non-operatively was 170.7 +/- 169.7 days while for those treated operatively was 536.6 +/- 300.4 days. Of the players treated with surgery, the mean time from injury to surgery was 97.5+/-115.5 days (range 12-453 days). The RTS rate among players treated non-operatively and operatively was identical at 75%. Players treated non-operatively had no change in ERA, FIP, or WAR following injury but had a higher WHIP after injury (p=0.039). Players treated operatively had no change in any measured performance metrics following surgery. No difference existed between cases and controls in the primary performance variables Conclusion: LD/TM tears occur more frequently than previously reported. The majority of LD/TM tears in professional baseball pitchers are treated non-operatively. RTS rate for professional baseball pitchers following LD/TM tears treated operatively or non-operatively is 75%. No significant difference in performance was seen in these pitchers following tear/surgery compared to matched controls.

Performance and Return to Sport After Latissimus Dorsi and Teres Major Tears Among Professional Baseball Pitchers

2019 ◽  
Vol 47 (5) ◽  
pp. 1090-1095 ◽  
Author(s):  
Brandon J. Erickson ◽  
Peter N. Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Anthony A. Romeo
Keyword(s):  
Latissimus Dorsi ◽  
Performance Metrics ◽  
Return To Sport ◽  
Nonoperative Treatment ◽  
Professional Baseball ◽  
Significant Difference ◽  
Major League ◽  
Teres Major ◽  
Baseball Pitchers ◽  
And Performance

Background: Latissimus dorsi and teres major (LD/TM) tears are becoming an increasingly common cause of injury and disability among professional baseball pitchers. Purpose/Hypothesis: To determine performance and return to sport (RTS) among professional baseball pitchers after LD/TM tears treated operatively and nonoperatively and to compare the RTS rate and performance between pitchers who sustained an LD/TM tear and matched controls. The authors hypothesized a high RTS rate among professional baseball pitchers after LD/TM tears, with no significant difference in RTS rate or performance between cases and controls for operative and nonoperative treatment—specifically, in the primary performance outcome variables of WHIP ([walks + hits] / innings pitched), fielding independent pitching, and wins above replacement. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball pitchers who sustained an LD/TM tear between 2011 and 2016 were identified with the Health and Injury Tracking System database of Major League Baseball. Demographic and performance data (before and after injury) were recorded for each player. Performance metrics were then compared between cases and matched controls by operative and nonoperative treatment. Results: Overall, 120 pitchers had a documented LD/TM tear; 42 (35%) were major league players. Most players (n = 107, 89.2%) were treated nonoperatively. Time to return to the same level of competition was 170 ± 169 days (mean ± SD) for pitchers treated nonoperatively and 406 ± 146 days for those treated operatively. The RTS rate among players treated nonoperatively and operatively was identical at 75%. Players treated nonoperatively had no change in fielding independent pitching or wins above replacement after injury but had a higher (ie, worse) WHIP after injury ( P = .039); they also performed significantly worse in several secondary performance metrics, including number of games played per year ( P < .001). Players treated operatively had no change in any measured performance metrics after surgery. No difference existed between cases and controls in the primary performance variables. Conclusion: The majority of LD/TM tears are treated nonoperatively. The RTS rate is 75% for professional baseball pitchers after LD/TM tears treated operatively or nonoperatively. Players treated nonoperatively saw a decline in several performance metrics, while players treated operatively had no significant difference in performance after surgery.

scholarly journals The Relationship between Scapular Upward Rotation and Shoulder Internal and External Rotation Isokinetic Strength in Professional Baseball Pitchers

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 759
Author(s):  
Byung Gon Kim ◽  
Seung Kil Lim ◽  
Sunga Kong
Keyword(s):  
External Rotation ◽  
Professional Baseball ◽  
Isokinetic Strength ◽  
Strength Ratio ◽  
Shoulder Injury ◽  
Isokinetic Dynamometer ◽  
Normal Range ◽  
History Of ◽  
Baseball Pitchers ◽  
The Relationship

This study aims to assess the relationship between scapular upward rotation (SUR) across varying humeral-elevation angles (HEAs) and shoulder isokinetic strength and ratio in professional baseball pitchers. The subjects were professional baseball pitchers (n = 16) without a history of shoulder injury in the last six months. The subject’s SUR angles were measured with the humerus elevated at HEAs of 0° (at rest), 60°, 90°, and 120° to the scapular plane. Shoulder isokinetic strength was evaluated for shoulder internal rotation (IR) and external rotation (ER) strength (PT%BW and TW%BW), and the ER/IR strength ratios were determined at 60, 120 and 180°/s using an isokinetic dynamometer. The SUR angle at an HEA of 0° was positively correlated with IR strength at 120°/s (r = 0.535) and 180°/s (r = 0.522). The SUR angle at an HEA of 60° was negatively correlated with the ER/IR strength ratios at 60°/s (r = −0.505) and 120°/s (r = −0.500). The SUR angle at an HEA of 90° was negatively correlated with the ER/IR strength ratios at 60°/s (r = −0.574; r = −0.554) and 120°/s (r = −0.521; r = −0.589) as well as with ER strength at 180°/s (r = −0.591, r = −0.556). The SUR angle at an HEA of 120° was negatively correlated with ER strength at 60°/s (r = −0.558), 120°/s (r = −0.504; r = −0.524), and 180°/s (r = −0.543) and the ER/IR strength ratio at 60°/s (r = −0.517). In this study, we found that the ratio of isokinetic strength between ER and IR became closer to the normal range on increasing the SUR angle. In particular, an HEA of 90°, which resembles the pitching motion, showed a clear relationship between SUR, shoulder ER, and the ratio of ER/IR isokinetic strength in professional baseball pitchers.

scholarly journals Performance and Return to Sport Following Ulnar Nerve Transposition/Decompression in Professional Baseball Players

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0016
Author(s):  
Brandon J. Erickson ◽  
Peter Nissen Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Anthony A. Romeo
Keyword(s):  
Ulnar Nerve ◽  
Performance Metrics ◽  
Return To Sport ◽  
Professional Baseball ◽  
Baseball Players ◽  
Nerve Decompression ◽  
Ulnar Nerve Transposition ◽  
Significant Difference ◽  
And Performance ◽  
Nerve Transposition

Background: Isolated ulnar nerve decompression/transposition is an uncommon surgery amongst professional baseball players. Purpose: To determine the rate of return to sport (RTS) and performance upon RTS in professional baseball players following isolated ulnar nerve decompression/transposition, including those who required an ulnar nerve transposition/decompression following ulnar collateral ligament reconstruction (UCLR), and to determine if outcomes differ between players with isolated ulnar nerve decompression/transposition and matched controls. Hypothesis: There is a high rate of RTS in professional baseball players undergoing isolated ulnar nerve decompression/transposition with no significant difference in RTS rate or performance (specifically related to the primary outcome performance variables of earned run average (ERA), WHIP ((walks +hits)/innings pitched), wins above replacement (WAR), and on base + slugging percentage (OPS)) between cases and controls. Methods: All professional baseball players who underwent isolated ulnar nerve decompression/transposition between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and a group of matched controls. Results: Overall 52 players, 83% pitchers (14 who underwent prior UCLR) were included. Most surgeries (92%) were anterior subcutaneous transpositions. Overall, 62% of players were able to successfully RTS and 56% returned to the same or a higher level. There was no significant difference between cases and controls in the majority of performance metrics pre-operative or post-operatively, specifically ERA, WHIP, WAR, and OPS. When players who had a UCLR prior to their ulnar nerve transposition/decompression were compared to controls with a history of a UCLR but who did not go on to have an ulnar nerve transposition/decompression, the only performance difference of all the recorded metrics was cases allowed more walks per 9 innings (4.4 vs. 2.8; p=0.011). Conclusion: Anterior subcutaneous transposition is the most common surgery in professional baseball players to address ulnar nerve compression. Players have a 62% rate of RTS. Upon RTS, players performance compared to matched controls remains the same in the majority of performance metrics including ERA, WHIP, WAR, and OPS. Post-operatively, pitchers with a UCLR prior to ulnar nerve transposition/decompression performed the same as matched controls with prior UCLR.

scholarly journals Performance and Return to Sport Following Open Reduction Internal Fixation About the Elbow in Professional Baseball Players

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0037
Author(s):  
Brandon J. Erickson ◽  
Peter Nissen Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Anthony A. Romeo
Keyword(s):  
Stress Fracture ◽  
Open Reduction ◽  
Performance Metrics ◽  
Return To Sport ◽  
Olecranon Fracture ◽  
Professional Baseball ◽  
Baseball Players ◽  
Significant Difference ◽  
And Performance ◽  
Olecranon Fractures

Objectives: The results of open reduction and internal fixation (ORIF) of stress reactions and fractures of the olecranon in professional baseball players with regards to return to sport (RTS) are unknown. The purpose was to determine the RTS rate and performance in professional baseball players following ORIF of acute, displaced olecranon fractures and olecranon stress fractures, and to compare RTS rate and performance to matched controls. The authors hypothesized that there is a high rate of RTS in professional baseball players following ORIF of acute, displaced olecranon fractures and olecranon stress fractures with no significant difference in rate of RTS or performance, specifically related to the primary outcome performance variables of win-loss percentage (W-L%), WHIP ((walks +hits)/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)) between cases and controls between cases and controls. Methods: All professional baseball players who underwent ORIF of the olecranon between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and a group of matched controls. Results: Overall, 52 professional baseball players (average age 22.6 +/- 3.6 years) underwent ORIF of an olecranon fracture. The majority of players sustained a primary olecranon stress fracture (73%), that was fixed with one screw (60%), with a RTS rate of 67.5%. No difference in RTS rate existed between matched controls and the players. No significant difference existed between the primary preoperative and postoperative performance (change in performance) metrics for pitchers who underwent ORIF of an acute, displaced olecranon fracture or ORIF of a primary olecranon stress fracture. No significant difference existed between pitchers who underwent ORIF of a primary olecranon stress fracture and matched controls in any of the primary performance metrics. Conclusion: Professional baseball players who undergo ORIF of an olecranon fracture (either acute, displaced or stress fracture) have a RTS rate of 67.5%, which is no different than natural attrition from matched controls. No decline in performance metrics is seen in players who are able to RTS when compared to their preoperative performance, or to the performance of matched controls.

scholarly journals Performance and Return to Sport After Thumb Ulnar Collateral Ligament Surgery in National Football League Players

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 487-493 ◽  
Author(s):  
Kyle R. Sochacki ◽  
Robert A. Jack ◽  
Richard Nauert ◽  
Shari R. Liberman ◽  
Patrick C. McCulloch ◽  
...  
Keyword(s):  
National Football League ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
High Rate ◽  
Collateral Ligament ◽  
Postoperative Performance ◽  
Paired Samples ◽  
Significant Difference ◽  
Postoperative Time ◽  
And Performance

Background: Acute ruptures of the ulnar collateral ligament (UCL) of the thumb are common injuries in sports. Surgical repair of complete tears has yielded excellent results in elite athletes. Methods: National Football League (NFL) players who underwent thumb UCL surgery and matched controls were identified. Demographic and performance data were collected. Performance scores were calculated using a standardized scoring system. Return to sport (RTS) in the NFL was defined as playing in at least 1 NFL game after thumb UCL surgery. Comparisons between case and control groups and preoperative and postoperative time points were made using paired-samples Student t tests. Results: Twenty-three players were identified (mean age: 28.8 ± 3.4 years and mean experience in the NFL: 5.9 ± 3.4 years). Twenty-two players (95.7%) were able to return to sport in the NFL at an average of 132.2 ± 126.1 days. The overall 1-year NFL career survival rate of players undergoing thumb UCL surgery was 87.0%. There was not a statistically significant decrease in games per season and career length for any position following surgery. No positions had a significant difference in postoperative performance when compared with preoperative performance, and there was no significant performance difference postoperatively when compared with matched controls. Conclusions: There is a high rate of RTS in the NFL following thumb UCL surgery. Players who underwent thumb UCL surgery played in a similar number of games per season and had similar career lengths in the NFL as controls. No position group had any significant postoperative performance score differences when compared with postindex matched controls.

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