Performance, Return to Competition, and Reinjury After Tommy John Surgery in Major League Baseball Pitchers: A Review of 147 Cases.
BACKGROUND
Pitching performance metrics, durability, and reinjury after Tommy John surgery in professional baseball players have not been well described.


OBJECTIVE
The purpose of this study was to determine the likelihood of return to professional competition, reinjury rate, and change in performance after Tommy John surgery in Major League Baseball pitchers. The hypothesis was that performance metrics and durability will decline after surgery.


METHODS
Cohort study; Level of evidence, 3.


METHODS
Publicly available records were accessed to generate a list of all Major League Baseball pitchers from 1999 to 2011 who had undergone ulnar collateral ligament reconstruction at any point in their careers; those with multiple reconstructive procedures were excluded. Return to active (≥1 game) or established (≥10 games) competition and/or placement on the disabled list was documented for each player. Among established players, pitching performance was compared pre- and postoperatively, as well as with age-matched control pitchers.


RESULTS
Of 147 pitchers included, 80% returned to pitch in at least 1 Major League Baseball game. Only 67% of established pitchers returned to the same level of competition postoperatively, and 57% of established players returned to the disabled list because of injuries to the throwing arm. Finally, performance declined across several metrics after surgery compared with preinjury levels, such as earned run average, batting average against, walks plus hits per inning pitched, percentage of pitches thrown in the strike zone, innings pitched, percentage fastballs thrown, and average fastball velocity (P < .05 for all). However, these declines were not statistically different from similar declines found in age-matched controls who did not undergo Tommy John surgery.


CONCLUSIONS
Return to the disabled list after Tommy John surgery is common among professional pitchers (>50%), and performance declines across several major metrics after surgery. Patients undergoing Tommy John surgery should be counseled appropriately regarding the likelihood of return to preinjury levels of competition and performance.
Center for Shoulder, Elbow, and Sports Medicine, Columbia University, New York, New York, USA.
Eric C
EC
Makhni
Center for Shoulder, Elbow, and Sports Medicine, Columbia University, New York, New York, USA.
Randall W
RW
Lee
Center for Shoulder, Elbow, and Sports Medicine, Columbia University, New York, New York, USA.
Zachary S
ZS
Morrow
Center for Shoulder, Elbow, and Sports Medicine, Columbia University, New York, New York, USA.
Anthony P
AP
Gualtieri
Department of Biostatistics, Columbia University, New York, New York, USA.
Prakash
P
Gorroochurn
Center for Shoulder, Elbow, and Sports Medicine, Columbia University, New York, New York, USA csa4@columbia.edu.
Christopher S
CS
Ahmad
D000328:Adult; D054874:Athletic Performance; D001484:Baseball / Q000293:injuries*; D015331:Cohort Studies; D017885:Collateral Ligaments / Q000293:injuries / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D000068958:Return to Sport; D055815:Young Adult
outcomes; professional baseball; ulnar collateral ligament reconstruction