Presentation Abstract

Session: 016-030-Sports Medicine/Arthroscopy I
Date/Time: Tuesday, Mar 11, 2014, 8:24 AM - 8:30 AM
Location Room 245
Presentation Number: Paper 019
Title: Performance Metrics Before and After Tommy John Surgery in 160 Professional Pitchers
Classification: +Elbow (including elbow arthroscopy and ligament reconstruction) (Sports Med/Arthro)
Keywords: Elbow / Tendon Injuries / Contracture / Radial Tunnel Syndrome; Elbow / Hand; Injuries; Outcomes
Author(s): Eric C. Makhni, MD, New York City, New York
Randall Lee, Hoboken, New Jersey
Zachary Morrow, BS, New York, New York
Anthony Gualtieri, BA, New York City, New York
Christopher S. Ahmad, MD, New York, New York
Abstract: INTRODUCTION: Major League Baseball (MLB) was forever changed after Tommy John underwent successful ulnar collateral ligament (UCL) reconstruction in 1974 by Dr. Frank Jobe. Since then, several hundred more professional players have undergone the procedure. This study investigates a battery of outcomes following Tommy John surgery of every professional pitcher undergoing this procedure since the hallmark surgery in 1974. These outcomes include rates of return to professional competition and to the disabled list for recurrent arm/elbow conditions, along with an analysis of several key performance metrics such as pitch/inning counts, opposing batting average, earned run average and fastball velocity.
METHODS: Public records were accessed and triple-verified to retrieve information regarding MLB pitchers who have undergone UCL reconstruction since 1974. Detailed performance metrics were collected before and after surgery for each pitcher, as was information regarding return to the disabled list post-operatively. Two-tailed t-tests were used to detect differences between average metrics before and after surgery. Pitchers were included with confirmed dates of surgery prior to the 2011 season who would therefore be eligible for participation in the 2012 season.
RESULTS: There were a total of 215 UCL reconstructions in 204 professional pitchers. Of these 215 surgeries, 34 were excluded as they were not confirmed prior to the 2011 season. Those who had undergone multiple surgeries (n=10 players, 21 surgeries) were excluded from analysis. Of the 160 professional pitchers undergoing Tommy John surgery, 28 failed to pitch ever again in the major league (18%). Those returning to major league competition returned at an average of 17 months following surgery. Moreover, 68 (52%) returned to the disabled list post-operatively due to a condition with their throwing arm, including 30 (23%) who returned for elbow-specific conditions. In the 105 pitchers who completed at least one entire season before and after surgery, detailed performance review indicated a decline in performance following surgery in several key pitching metrics. These include earned run average (4.66 from 4.22;p=0.006), opposing batting average (0.258 from 0.249;p=0.015), walks and hits per inning (1.44 from 1.37;p=0.005) and innings played (80.4 from 98.6;p<0.001). Finally, the percentage of fastballs thrown and fastball velocity also decreased after surgery (63.9% vs. 59.0%; p<0.001, and 90.8 vs. 91.2 mph; p=0.023, respectively).
DISCUSSION AND CONCLUSION: This study represents the largest analysis of major league baseball pitchers that have undergone Tommy John surgery with inclusion of well-accepted performance indices. There have been 215 ulnar collateral reconstructions performed on Major League Baseball pitchers. There is a significant proportion of players (18%) who do not resume major league career. For those that return, a high proportion return to the disabled list, both for arm conditions (in general) and specifically for elbow pain (47% and 23%, respectively). Moreover, many performance statistics showed a decline following surgery, most notably in ERA, WHIP, opposing batting average, innings pitched, percentage of fastballs thrown and fastball velocity.

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