Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, New York, USA.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA.
Am J Sports Med. 2019 Apr;47(5):1090-1095. doi: 10.1177/0363546519829086. Epub 2019 Mar 21.
Latissimus dorsi and teres major (LD/TM) tears are becoming an increasingly common cause of injury and disability among professional baseball pitchers.
PURPOSE/HYPOTHESIS: To determine performance and return to sport (RTS) among professional baseball pitchers after LD/TM tears treated operatively and nonoperatively and to compare the RTS rate and performance between pitchers who sustained an LD/TM tear and matched controls. The authors hypothesized a high RTS rate among professional baseball pitchers after LD/TM tears, with no significant difference in RTS rate or performance between cases and controls for operative and nonoperative treatment-specifically, in the primary performance outcome variables of WHIP ([walks + hits] / innings pitched), fielding independent pitching, and wins above replacement.
Cohort study; Level of evidence, 3.
All professional baseball pitchers who sustained an LD/TM tear between 2011 and 2016 were identified with the Health and Injury Tracking System database of Major League Baseball. Demographic and performance data (before and after injury) were recorded for each player. Performance metrics were then compared between cases and matched controls by operative and nonoperative treatment.
Overall, 120 pitchers had a documented LD/TM tear; 42 (35%) were major league players. Most players (n = 107, 89.2%) were treated nonoperatively. Time to return to the same level of competition was 170 ± 169 days (mean ± SD) for pitchers treated nonoperatively and 406 ± 146 days for those treated operatively. The RTS rate among players treated nonoperatively and operatively was identical at 75%. Players treated nonoperatively had no change in fielding independent pitching or wins above replacement after injury but had a higher (ie, worse) WHIP after injury ( P = .039); they also performed significantly worse in several secondary performance metrics, including number of games played per year ( P < .001). Players treated operatively had no change in any measured performance metrics after surgery. No difference existed between cases and controls in the primary performance variables.
The majority of LD/TM tears are treated nonoperatively. The RTS rate is 75% for professional baseball pitchers after LD/TM tears treated operatively or nonoperatively. Players treated nonoperatively saw a decline in several performance metrics, while players treated operatively had no significant difference in performance after surgery.
Latissimus dorsi 和teres major（LD/TM）撕裂在职业棒球投手中已成为越来越常见的受伤和残疾原因。
目的/假设：确定 LD/TM 撕裂后接受手术和非手术治疗的职业棒球投手的表现和重返运动（RTS）情况，并比较发生 LD/TM 撕裂的投手和匹配对照者之间的 RTS 率和表现。作者假设 LD/TM 撕裂后职业棒球投手的 RTS 率较高，并且在手术和非手术治疗的情况下，RTS 率或表现均无明显差异-具体来说，在主要表现结果变量 WHIP（[保送+安打] /投球局数）、守备率和胜场数方面。
队列研究；证据水平，3 级。
使用 Major League Baseball 的健康和伤害跟踪系统数据库确定在 2011 年至 2016 年间发生 LD/TM 撕裂的所有职业棒球投手。为每位球员记录人口统计学和表现数据（受伤前后）。然后，通过手术和非手术治疗比较病例和匹配对照之间的表现指标。
共有 120 名投手记录有 LD/TM 撕裂；其中 42 名（35%）为大联盟球员。大多数球员（n=107，89.2%）接受非手术治疗。非手术治疗的投手重返相同比赛水平的时间为 170±169 天（平均值±标准差），手术治疗的投手为 406±146 天。非手术和手术治疗的投手 RTS 率相同，为 75%。接受非手术治疗的球员受伤后守备率和胜场数均无变化，但受伤后 WHIP 更高（即表现更差）（P=0.039）；他们在几个次要表现指标上的表现也明显下降，包括每年参加的比赛次数（P<0.001）。手术治疗的投手手术后任何测量的表现指标均无变化。病例与对照组在主要表现变量上无差异。
大多数 LD/TM 撕裂都接受非手术治疗。LD/TM 撕裂后接受手术和非手术治疗的职业棒球投手的 RTS 率为 75%。接受非手术治疗的球员的多项表现指标下降，而接受手术治疗的球员手术后的表现无显著差异。
