Relative individual workload changes may be a risk factor for rerupture of ulnar collateral ligament reconstruction.
BACKGROUND
With an increasing number of Major League Baseball (MLB) players undergoing ulnar collateral ligament (UCL) reconstruction, there remains limited literature on appropriate post-reconstruction workload management to limit the risk of reinjury.


METHODS
A total of 28 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction were identified and compared with 137 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared 3 years before and after primary reconstruction. Results were then compared between groups.


RESULTS
Pitchers who later required revision increased their games pitched by 14.1% after reconstruction whereas the no-revision group pitched 13.6% fewer games than before reconstruction (P < .01). Inning workload was reduced by 9.8% after surgery (89.8 innings after vs 99.6 innings before) for the revision group compared with the no-revision group, which threw 26% fewer innings after surgery (86.3 innings after vs 116.7 innings before) (P = .05). In addition, the revision group pitched 6.6% more pitches after reconstruction, 1138.9 pitches, compared with before reconstruction, 1068.6 pitches. Pitchers who did not require revision, in contrast, pitched 19.6% fewer pitches after reconstruction than before reconstruction (P = .08).


CONCLUSIONS
This study's findings suggest that MLB pitchers who require revision UCL reconstruction after returning to play following primary UCL reconstruction pitch at or above their pre-primary UCL reconstruction workload whereas control pitchers who do not require revision pitch significantly less, below their pre-primary UCL reconstruction workload.
Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA. Electronic address: robkeller23@gmail.com.
Robert A
RA
Keller
Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA.
Nima
N
Mehran
Wayne State University School of Medicine, Detroit, MI, USA.
Lafi S
LS
Khalil
Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University, New York, NY, USA.
Christopher S
CS
Ahmad
Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA.
Neal
N
ElAttrache
D000328:Adult; D001484:Baseball / Q000293:injuries*; D000070637:Collateral Ligament, Ulnar / Q000293:injuries* / Q000601:surgery; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010807:Physical Endurance / Q000502:physiology*; D012086:Reoperation; D012307:Risk Factors; D000070638:Ulnar Collateral Ligament Reconstruction / Q000379:methods*; D055815:Young Adult; D000092464:Elbow Injuries
MLB; UCL; baseball; innings pitched; pitch count; pitcher; revision