Successful Performance After Ulnar Collateral Ligament Reconstruction: An Analysis of 88 Drafted Professional Baseball Pitchers With a Matched Comparison Cohort. Issue 11 (11th November 2019) - Griffith, Timothy B.
Background: Analysis of pitchers entering the Major League Baseball (MLB) draft after ulnar collateral ligament reconstruction (UCLR) is challenging for team physicians. Purpose: (1) To define the characteristics of pitchers drafted after UCLR associated with placement in AAA and MLB professional levels and completion of a career of at least 3 years, (2) to define characteristics placing pitchers at risk for reinjury after surgery, (3) to compare the professional-level placement and career duration of the UCLR cohort with a matched control group, and (4) to evaluate the accuracy of team physician predraft risk assessments to predict elbow reinjury in pitchers with a history of UCLR. Study Design: Cohort study; Level of evidence, 3. Methods: We analyzed pitchers from a single professional baseball team database who were drafted after UCLR from 2010 to 2013. A matched control group based on position and draft year was selected with the MLB database. The following pitcher characteristics were analyzed: age at the time of UCLR, time from UCLR to the MLB draft, pitching role (starter vs reliever), highest level of play attained, body mass index (BMI), throwing-side dominance, and predraft physician risk assessment. Physician assessments to predict risk for elbow reinjury were derived from operative and clinical history and evaluated for accuracy during the follow-up period. Pitcher characteristics were evaluated for correlation with successful AAA or MLB placement with a career duration of at least 3 years and as risk factors for elbow reinjury. The professional-level achievement and career duration of the UCLR cohort were compared with the matched cohort. Results: A total of 88 pitchers matched the selection criteria and had at least 5 years of follow-up (range, 5-8 years). Pitcher age at the time of UCLR ( P = .55), throwing-side dominance ( P = .41), and BMI ( P = .86) did not correlate with AAA- or MLB-level placement. Relief pitchers ( P = .03) and pitchers with a longer time from surgery to final follow-up ( P = .02) were more likely to reach the AAA or MLB level. Similarly, pitcher age at the time of UCLR ( P = .56), throwing-side dominance ( P = .27), and BMI ( P = .69) did not correlate with a duration of play of at least 3 years. Relief pitchers ( P = .03) and pitchers with a longer time from UCLR to the final follow-up ( P = .005) were more likely to achieve at least 3 years of play. There was no difference in AAA or MLB placement between the UCLR and matched cohorts ( P = .22). The UCLR cohort achieved a higher duration of play than the matched cohort ( P = .002). Pitchers with a BMI >25 kg/m 2 had a lower risk of elbow reinjury versus players with a BMI ≤25 kg/m 2 ( P = .012). Patient age at time of UCLR ( P = .92), time from UCLR to the MLB draft ( P = .18), pitching role ( P = .74), and throwing-side dominance ( P = .77) did not correlate with elbow reinjury. Physician risk assessment did not accurately predict reinjury ( P = .27). Of the 88 patients, 4 (4.5%) required revision UCLR. Conclusion: Pitcher age at the time of UCLR, throwing-side dominance, and BMI did not correlate with performance. Relief pitchers and players with a longer time from surgery to final follow-up were more likely to reach AAA and MLB levels and achieve at least a 3-year duration of play. Pitchers with a greater BMI had a lower risk of reinjury. After UCLR, pitchers were able to perform at least as well as the matched nonsurgical cohort. Physician risk assessment at the time of the draft was not accurate at predicting reinjury.