Should We Limit Innings Pitched Following Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers?

BACKGROUND Ulnar collateral ligament reconstruction is commonly performed in major league pitchers, but little is known about pitching performance after a return to major league play. HYPOTHESIS Pitching performance after ulnar collateral ligament reconstruction returns to baseline by the second season after surgery. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS Data were reviewed for 68 major league pitchers who pitched in at least 1 major league game before undergoing ulnar collateral ligament reconstruction between 1998 and 2003. Mean innings pitched per season, earned run average, and walks and hits per inning pitched were compared for each major league pitcher before and after surgery. All demographic and performance variables were analyzed for an association with ulnar collateral ligament insufficiency and a successful return to major league play. RESULTS Fifty-six (82%) pitchers returned to major league play at a mean of 18.5 months after surgery with no significant change in mean earned run average or walks and hits per inning pitched. The mean innings pitched per season was not statistically different from controls by the second season after surgery. Starting pitchers demonstrated a higher risk of ulnar collateral ligament injury requiring reconstruction. More experienced pitchers and those with a higher earned run average were less likely to require ulnar collateral ligament reconstruction. No factors predictive of a successful return to play were identified. CONCLUSION Most major league pitchers return from ulnar collateral ligament reconstruction by the second season after surgery with no statistical change in mean innings pitched, earned run average, or walks and hits per inning pitched from preinjury levels.