Trends in Revision Elbow Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers.
OBJECTIVE
To determine the frequency of revision elbow ulnar collateral ligament (UCL) reconstruction in professional baseball pitchers.


METHODS
Data were collected on 271 professional baseball pitchers who underwent primary UCL reconstruction. Each player was evaluated retrospectively for occurrence of revision UCL reconstructive surgery to treat failed primary reconstruction. Data on players who underwent revision UCL reconstruction were compiled to determine total surgical revision incidence and revision rate by year. The incidence of early revision was analyzed for trends. Average career length after primary UCL reconstruction was calculated and compared with that of players who underwent revision surgery. Logistic regression analysis was performed to assess risk factors for revision including handedness, pitching role, and age at the time of primary reconstruction.


RESULTS
Between 1974 and 2014, the annual incidence of primary UCL reconstructions among professional pitchers increased, while the proportion of cases being revised per year decreased. Of the 271 pitchers included in the study, 40 (15%) required at least 1 revision procedure during their playing career. Three cases required a second UCL revision reconstruction. The average time from primary surgery to revision was 5.2 ± 3.2 years (range, 1-13 years). The average length of career following primary reconstruction for all players was 4.9 ± 4.3 years (range, 0-22 years). The average length of career following revision UCL reconstruction was 2.5 ± 2.4 years (range, 0-8 years). No risk factors for needing revision UCL reconstruction were identified.


CONCLUSIONS
The incidence of primary UCL reconstructions among professional pitchers is increasing; however, the rate of primary reconstructions requiring revision is decreasing. Explanations for the decreased revision rate may include improved surgical technique and improved rehabilitation protocols.


METHODS
Therapeutic IV.
Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI.
Alexander T
AT
Wilson
Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI. Electronic address: Tyler_Pidgeon@brown.edu.
Tyler S
TS
Pidgeon
Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI.
Nathan T
NT
Morrell
Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI.
Manuel F
MF
DaSilva
D000328:Adult; D054874:Athletic Performance; D001484:Baseball / Q000293:injuries*; D017885:Collateral Ligaments / Q000293:injuries* / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012086:Reoperation; D012307:Risk Factors; D000092464:Elbow Injuries
Baseball; Tommy John surgery; reconstruction; revision; ulnar collateral ligament