Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Abstract

Background: Ulnar collateral ligament (UCL) reconstruction of the elbow is commonly performed on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. Purpose: To provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Study Design: Case series; Level of evidence, 4. Methods: The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS, and surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play [RTP] rates, RTP times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (docking vs modified Jobe) and graft sources (palmaris longus autograft vs hamstring autograft). Results: A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1424 days (47 months) after their primary surgery. A trend was seen toward increasing numbers of revision surgeries over time ( R2 = 0.441; P = .104). The most commonly used tunnel configuration was the modified Jobe technique (n = 41; 59.4%), and the most commonly used graft was hamstring autograft (n = 34; 49.3%). A majority (76.6%) of pitchers achieved RTP, and 55.3% were able to return to the same level of play. Mean time to RTP was 436 days (14.5 months) for players with a palmaris longus autograft versus 540 days (18 months) for those with a hamstring autograft ( P = .108). Further, the mean time to RTP was 423 days (14 months) for the docking technique versus 519 days (17 months) for the modified Jobe technique ( P = .296). Similar rates of subsequent injuries and surgeries were noted between the 2 revision techniques and 2 most commonly used graft constructs. Conclusion: Revision UCL reconstruction showed relatively high RTP rates (77%), but only 55% of players returned to their same level of play. Mean time to RTP was shorter than that found in other, smaller investigations. Although general trends were seen toward decreased time to RTP for the docking technique and palmaris longus autograft, these differences did not reach statistical significance.

Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

“… 8 , 35 In a study of professional baseball pitchers, there was an increasing trend of revision UCL from 2010 to 2016 in both Major League Baseball (MLB) and Minor League Baseball (MiLB) players. 10 In this work, the overall mean revision UCL rate was 6.7%, with a rate of 9.4% in MLB and 5.2% in MiLB players ( P = .004).…”

Return-to-Play and Competitive Outcomes After Ulnar Collateral Ligament Reconstruction Among Baseball Players: A Systematic Review

“…RTP rates for MLB pitchers after primary UCLR ranged from 80% to 97% with a mean of 12 months until RTP, 16,22,23,25,28,34,41,42 while RTSP rates ranged from 67% to 87% with almost 15 months until RTP. 16,22,23,25,28,34,39,41,42 RTP rates for MLB pitchers after revision UCLR were slightly lower, ranging from 77% to 85%, 5,43 while RTSP rates ranged from 55% to 78%. 5,30,37,43 There were 3 studies 2,3,27 that analyzed RTP of MLB position players, but only Camp et al 3 had a sufficient sample size after separating the position players into infielders (n ¼ 34), outfielders (n ¼ 35), and catchers (n ¼ 24).…”

“…16,22,23,25,28,34,39,41,42 RTP rates for MLB pitchers after revision UCLR were slightly lower, ranging from 77% to 85%, 5,43 while RTSP rates ranged from 55% to 78%. 5,30,37,43 There were 3 studies 2,3,27 that analyzed RTP of MLB position players, but only Camp et al 3 had a sufficient sample size after separating the position players into infielders (n ¼ 34), outfielders (n ¼ 35), and catchers (n ¼ 24). For position players, infielders returned to play the fastest (294 days), outpacing outfielders (375 days) and catchers (363 days).…”

“…Data extracted related to the 20 studies {{ that assessed RTP outcomes are found in Appendix Table A2. Overall, 12 studies ## assessed primary UCLR in pitchers, 4 studies 5,30,37,43 focused on revision UCLR in pitchers, 1 study 15 assessed both primary and revision UCLR in pitchers, 3 studies 2,3,27 analyzed primary UCLR in position players, and 1 study 40 looked at catchers after primary UCLR. All of the included RTP outcome studies assessed professional players.…”

State of the Union on Ulnar Collateral Ligament Reconstruction in 2020: Indications, Techniques, and Outcomes

“…A detailed description of the epidemiology, diagnosis, and surgical considerations for revision UCL reconstruction are beyond the scope of this review. Recent publications have provided such information [101,[104][105][106].…”