In Reply:

Abstract

We appreciate both the interest in our recent article, “Trends in revision elbow ulnar collateral ligament reconstruction in professional baseball pitchers,” and the thoughtful critique of our methodology.1Wilson A.T. Pidgeon T.S. Morrell N.T. DaSilva M.F. Trends in revision elbow ulnar collateral ligament reconstruction in professional baseball pitchers.J Hand Surg Am. 2015; 40: 2249-2254Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar The primary criticism made of our article is that by reporting the revision rate of elbow ulnar collateral ligament (UCL) reconstructions in Major League Baseball (MLB) pitchers by year of index surgery and including most recent years, our study skews the data in favor of decreased UCL revision rates. As Dr. Liu points out, this is because patients undergoing recent UCL reconstructions have not yet gone through enough rehab (average of 20.5 months) to return to sport and, thus, have not yet risked damage to their reconstructed UCL.2Erickson B.J. Gupta A.K. Harris J.D. et al.Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers.Am J Sports Med. 2014; 42: 536-543Crossref PubMed Scopus (235) Google Scholar The article does acknowledge this; however, the average time from primary surgery to revision surgery was 5 years. We feel that this indicates that the majority of patients operated on, even as recently as 2009, would have been followed for at least the average amount of time to failure determined by this study.1Wilson A.T. Pidgeon T.S. Morrell N.T. DaSilva M.F. Trends in revision elbow ulnar collateral ligament reconstruction in professional baseball pitchers.J Hand Surg Am. 2015; 40: 2249-2254Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar In fact, if all data for surgery after 2009 are disregarded, the primary message of the study remains the same: the number of UCL revision procedures in MLB pitchers is increasing; however, it is increasing at a rate that is less than the increase in primary surgeries. Figure 1 includes data from procedures done in 2009 or earlier, ensuring that all included patients have had at least 20.5 months of rehabilitation and are at least 5 years out from their primary reconstruction.1Wilson A.T. Pidgeon T.S. Morrell N.T. DaSilva M.F. Trends in revision elbow ulnar collateral ligament reconstruction in professional baseball pitchers.J Hand Surg Am. 2015; 40: 2249-2254Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar, 2Erickson B.J. Gupta A.K. Harris J.D. et al.Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers.Am J Sports Med. 2014; 42: 536-543Crossref PubMed Scopus (235) Google Scholar This shows that the rate of increase in primary UCL reconstructions is greater than the rate of increase in revision reconstructions and the difference between these 2 trend lines remains significant. We feel that presenting our data with regard to revision UCL reconstruction in terms of the date of the index surgery allows a clearer understanding of revision rates. Dr. Liu also points out that, in 2014, revision surgery accounted for one-third of all UCL reconstructions in MLB pitchers. Although this is an interesting finding, it should be considered in the context of the 40 years of data our study describes. Revision UCL surgery rates may be starting to increase; however, the rate of increase in primary surgery is outpacing the rate of increase in revision surgeries. In the future, it may be interesting to determine whether or not the respective rates of primary and revision reconstruction change. Letter Regarding “Trends in Revision Elbow Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers”Journal of Hand SurgeryVol. 41Issue 4PreviewWe read with great interest Wilson et al’s recent article1 on trends in revision elbow ulnar collateral ligament reconstruction (UCL-R). The article concluded that whereas the rate of primary reconstructions in Major League Baseball (MLB) pitchers is increasing, the revision rate is, in contrast, decreasing. In particular, they determined that the rate of revision was decreasing because the proportion of primary elbow UCL-Rs per index year requiring revision in MLB pitchers has decreased since 1976 when the first Tommy John Surgery was performed. Full-Text PDF