Should We Limit Innings Pitched After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers?
Ulnar collateral ligament (UCL) tears have become com- mon injuries among Major League Baseball (MLB) pitchers. The current treatment recommendation for elite- level pitchers with UCL tears who fail nonoperative treatment is a UCL reconstruction (UCLR). This procedure has undergone several modifications since its initial description by Dr Frank Jobe but essentially involves reconstruction of the UCL with a tendon graft (allograft or autograft) fixed on both the medial epicondyle and sublime tubercle in one of a variety of ways. Recent survey data from Conte have shown that 25% of MLB pitchers surveyed had a history of a UCLR. Furthermore, with the recent increase in the number of primary UCLRs, the overall number of revision UCLRs has also increased (although the proportion of cases requiring revision each year has decreased). Although the results after primary UCLR in MLB pitchers have been encouraging, with a greater than 80% return-to-sport (RTS) rate in MLB and a greater than 90% RTS rate in either the minor or major leagues, the results for revision UCLR are less predictable.
Despite an increase in the overall number of revision UCLRs performed in MLB pitchers in recent years, risk factors for failure after primary UCLR have not been well elucidated. There is speculation that limiting the number of innings pitched in a player’s first full season back to MLB, as well as in his overall career, will decrease the player’s risk for reinjury. Remarkably, postoperative protocols after UCLR differ among surgeons who care for professional baseball players, not only with regard to the early postoperative protection and mobilization of the surgical site but also in the pace and intensity of rehabilitation leading to return to sport. Some limit the number of innings pitched in a single season to 180 innings, while others have no limit on the number of innings pitched after UCLR. No current data provide scientific support of one practice over the other.
The purpose of this study was to determine whether the number of innings pitched or number of pitches thrown in the first full season after UCLR as well as over the pitcher’s MLB career affected the pitcher’s need for a revision UCLR. We hypothesized that the number of innings pitched and number of pitches thrown in the first full sea- son after UCLR as well as over the pitcher’s career will have no significant effect on whether the pitcher developed elbow symptoms that led to revision UCLR.