SEATTLE— Eighty-seven percent of Major League Baseball (MLB) pitchers who underwent ulnar collateral ligament (UCL) reconstructive surgery returned to the Major League level of sport, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. However, the study also documented a decline in pitching performance after undergoing reconstructive surgery. Entering the Major Leagues at a younger age also increased a player’s risk for requiring surgery.
A tremendous amount of stress is placed on the elbow while pitching a baseball. Due to these stresses, MLB pitchers are at increased risk for UCL injuries. Robert A. Keller, MD, of Henry Ford Hospital in Detroit, Michigan, and colleagues, reviewed the statistics for 168 MLB pitchers, who threw at least 1 season at the Major League level and underwent UCL reconstruction. Statistical data, including earned run average (ERA), walks and hits per innings pitched (WHIP), win percentage, innings pitched, and salary were compared for the 3 years before and 3 years after undergoing UCL reconstruction. “Having athletic trainers and team physicians closely look at when players pitching performance stats start to decrease may allow for steps to be taken with a pitcher before a surgery is needed,” said Dr. Keller.
Of the 87% of pitchers that returned to the Major League level after undergoing UCL reconstruction, a statistically significant decline in their ERA (P = 0.001), WHIP (P = 0.011), and innings pitched (P = 0.026) was seen compared to pre-reconstruction performance. Reconstructed pitchers also had a statistically decline in their pitching performance in the season before their surgery (ERA P = 0.014, WHIP P = 0.036, innings pitched P < 0.001, win percentage P = 0.004). Approximately 60% of pitchers requiring UCL reconstruction had surgery within the first 5 years of being in the Major Leagues. Validated by a multivariable generalized estimating equation model that examined risk factors, arm stress from earlier Major League experience contributed to injury. In addition, players who entered the MLB at an earlier age also appeared to have a greater risk for surgery.
“Our results suggest that UCL reconstructive surgery does a tremendous job in allowing players to return to their same level of sport but it also describes a decline in pitching performance after undergoing reconstruction,” said Dr. Keller. “Our study also further highlights the need for kids not to overuse their arms early in their pitching careers.”