Pitching Performance and Longevity After Revision Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

Background: Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on professional pitchers in Major League Baseball (MLB). Although a great deal is known about primary reconstruction, much less is known about revision reconstruction. Purpose/Hypothesis: The purpose of this study was to evaluate statistical performance, return to play, and career longevity in MLB pitchers after revision UCL surgery, with the hypothesis that pitching performance and career longevity will decline after revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 33 MLB pitchers who underwent revision UCL reconstruction surgery (UCL-R group) were identified and compared with 33 age- and position-matched controls (CTL group). Return to play, total years played, and statistical performance were evaluated and compared with controls. Results: After revision surgery, 65.5% of UCL-R pitchers returned to the MLB level. On average, the UCL-R pitchers played 0.8 years less in the majors (P < .01) than did the control pitchers. The UCL-R pitchers who returned to the MLB level had a similar earned run average (UCL-R: 4.88, CTL: 4.76, P = .82) and walks/hits per innings pitched (UCL-R: 1.58, CTL: 1.44, P = .22) compared with the control pitchers. There were significant declines, however, in terms of innings pitched (UCL-R: 36.95, CTL: 75.00, P < .01), walks per 9 innings (UCL-R: 4.75, CTL: 3.49, P < .01), and wins (UCL-R: 1.88, CTL: 4.10, P < .01) as well as nonsignificant declines in wins above replacement (UCL-R: 0.25, CTL: 0.62, P = .06) and runs above replacement (UCL-R: 3.26, CTL: 6.91, P = .07). Conclusion: MLB pitchers who undergo UCL-R have a low rate of return to MLB play and have shortened careers after return. Pitchers who returned to the MLB level maintained performance in several statistics such as earned run average and walks/hits per innings pitched; however, pitchers returned with a significantly decreased workload.