Epidemiology of ulnar collateral ligament reconstruction in Major and Minor League Baseball pitchers: comprehensive report of 1429 cases

Abstract

Background: The primary purpose of this work is to provide an epidemiologic report on every known ulnar collateral ligament (UCL) reconstruction performed in professional baseball with a special focus on outcomes and survivorship.

Methods: Three resources, including the Major League Baseball (MLB) injury tracking system, were combined and cross-referenced to identify all known professional baseball pitchers who had ever undergone UCL reconstruction from 1974 to 2016. Variables analyzed included injury date, surgery date, return to play rates, time out of play, and revision status. Trends over time were analyzed collectively and by level of play at the time of surgery. A minimum of 2 years of follow-up was required for return to play analysis.

Results: We identified 1429 UCL reconstructions. The annual rate of primary and revision UCL reconstructions rose significantly (P < .001). Most players (83.7%) returned to any level of play at a mean of 435 days, whereas 72.8% (P < .001) returned to their prior level at a mean of 506 days. Major League Baseball players were more likely than Minor League Baseball players to return to any level (94.6% vs. 79.0%, P < .001) and their prior level of performance (80.0% vs. 69.1%, P = .04). The mean overall survivorship free from revision and still playing was 3.8 years (3.9 for primary vs. 2.9 for revisions, P = .018). The revision rate was 6.7% and was higher for Major League Baseball (9.4%) vs. Minor League Baseball (5.2%, P = .004).

Conclusions: This study represents the most robust epidemiologic report of UCL reconstruction in baseball to date, and a multitude of novel findings are reported.

Keywords: Major League Baseball; Minor League Baseball; Tommy John; elbow; pitchers; professional baseball; ulnar collateral ligament.