title: Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.
abstract: BACKGROUND
  Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers.
  
  
  METHODS
  We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery.
  
  
  RESULTS
  The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P < .001) and had less MLB experience (1.5 years vs. 5.0 years, P < .001).
  
  
  CONCLUSIONS
  There is no specific number of pitches, innings, or games that place a pitcher at an increase risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction.
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA. Electronic address: robkeller23@gmail.com.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Keller
authors.affiliation: Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA, USA.
authors.forename: Nima
authors.initials: N
authors.lastname: Mehran
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Marshall
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Kelechi R
authors.initials: KR
authors.lastname: Okoroha
authors.affiliation: Wayne State University Medical School, Detroit, MI, USA.
authors.forename: Lafi
authors.initials: L
authors.lastname: Khalil
authors.affiliation: Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Tibone
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Moutzouros
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000517:prevention & control*; D001484:Baseball / Q000293:injuries*; D016022:Case-Control Studies; D000070637:Collateral Ligament, Ulnar / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery; D006801:Humans; D008297:Male; D010807:Physical Endurance; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D000070638:Ulnar Collateral Ligament Reconstruction; D055815:Young Adult; D000092464:Elbow Injuries
keywords: MLB; UCL; baseball; innings pitched; pitch count; pitcher; revision