title: Outcomes in revision Tommy John surgery in Major League Baseball pitchers.
abstract: BACKGROUND
  With the recent rise in the number of Tommy John surgeries, a proportionate rise in revisions is expected. However, much is unknown regarding the current revision rate of Tommy John surgery, return to play, and change in performance in Major League Baseball (MLB) pitchers.
  
  
  METHODS
  Publicly available databases were used to obtain a list of all MLB pitchers who underwent primary and revision Tommy John surgery. Pitching performance preoperatively and postoperatively for pitchers who returned to 1 or more MLB games after revision surgery was compared with controls matched for age and position.
  
  
  RESULTS
  Since 1999, 235 MLB pitchers have undergone Tommy John surgeries; 31 pitchers (13.2%) underwent revision surgery, and 37% underwent revision within 3 years of the index procedure. Twenty-six revisions had more than 2 years of follow-up; 17 pitchers (65.4%) returned to pitch at least 1 major league game, whereas only 11 (42.3%) returned to pitch 10 or more games. Of those who returned to MLB competition, the average length of recovery was 20.76 months. Compared with controls matched for age and position, MLB pitchers undergoing revision surgery had a statistically shorter career after revision surgery (4.9 vs 2.6 seasons, P = .002), pitched fewer innings, and had fewer total pitches per season.
  
  
  CONCLUSIONS
  The rate of revision Tommy John surgery is substantially higher than previously reported. For MLB pitchers, return to play after revision surgery is much lower than after primary reconstruction. The overall durability of MLB pitchers after revision ulnar collateral ligament reconstruction decreases significantly compared with controls matched for age and matched controls.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. Electronic address: liuj@hss.edu.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Grant H
authors.initials: GH
authors.lastname: Garcia
authors.affiliation: Los Angeles Dodgers Baseball Club, Los Angeles, CA, USA.
authors.forename: Stan
authors.initials: S
authors.lastname: Conte
authors.affiliation: Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA.
authors.forename: Neal
authors.initials: N
authors.lastname: ElAttrache
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Altchek
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Dines
mesh_terms: D000328:Adult; D054874:Athletic Performance / Q000706:statistics & numerical data*; D001484:Baseball / Q000293:injuries*; D017885:Collateral Ligaments / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D004850:Eponyms; D006801:Humans; D019637:Orthopedic Procedures / Q000706:statistics & numerical data* / Q000639:trends; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000068958:Return to Sport / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Major League Baseball; Tommy John surgery; Ulnar collateral ligament; pitching; return to sport; revision