Major League Baseball Pitching Performance after Tommy John Surgery and the effect of Tear Characteristics, Technique, and Graft Type

Abstract

Objectives: Return to play and player satisfaction has been quite high after ulnar collateral ligament reconstruction (UCLR), however, there has been little reported on how outcomes are affected by surgical technique, graft type and tear characteristics. The purpose was to evaluate surgical techniques, graft type and tear characteristics on MLB performance after UCLR. Methods: MLB pitchers that underwent primary UCLR at a single institution were included. Tear characteristics included tear location, tear grade and acuity. Surgical technique and graft type was also collected. Pitching performance statistics, including earned run average (ERA), Walks hits per innings pitched (WHIP), innings pitched, and fastball velocity were evaluated 3 years pre- and post-UCLR. Results: 46 MLB pitchers were identified having primary UCLR. Return to play was 96%, with 82% returning to MLB play. Technique performed showed no difference in performance. Pitchers with palmaris grafts were younger (p=0.043), played longer after surgery (p=0.007), and returned to play at 100% (35/35) vs. 82% (9/11) of gracilis grafts (p=0.011). Pitchers with distal tears pitched at higher velocity (93.0 vs. 90.6 mph)(p=0.023) and had better performance (ERA, p=0.003; WHIP, p=0.003) prior to surgery, with proximal tears improving to match this performance and velocity after reconstructionhigher . Pitchers with complete tears played longer after surgery (5.9 vs. 4.0 years)(p=0.033), had better ERA (p=0.041) prior to injury and better WHIP (p=0.037) and strikeouts/9 innings (p=0.025) after reconstruction vs. partial tears. Chronic tears had a significant improvement in ERA from 4.49 to 3.80 (p=0.040) postoperatively. Conclusion: Technique performed and graft type used did not affect performance, however, palmaris grafts returned at a higher rate than gracilis grafts. Distal tears occurred in pitchers with greater velocity and better performance prior to injury with proximal tears matching this performance after reconstruction. Pitchers with complete tears played longer after reconstruction. Pitchers who had partial tears had worse performance prior to injury and after reconstruction and chronic tears saw a significant improvement in ERA with reconstruction.