Thomas Stephen J, Paul Ryan W, Rosen Adam B, Wilkins Sam J, Scheidt Joseph, Kelly John D, Crotin Ryan L
College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Penn Throwing Clinic, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Orthop J Sports Med. 2020 Dec 28;8(12):2325967120966310. doi: 10.1177/2325967120966310. eCollection 2020 Dec.
Ulnar collateral ligament (UCL) reconstruction (UCLR) is very common in baseball. However, no review has compared the return-to-play (RTP) and in-game performance statistics of pitchers after primary and revision UCLR as well as of position players after UCLR.
To review, synthesize, and evaluate the published literature on outcomes after UCLR in baseball players to determine RTP and competitive outcomes among various populations of baseball players.
Systematic review; Level of evidence, 4.
A literature search including studies between 1980 and November 4, 2019, was conducted for articles that included the following terms: ulnar collateral ligament, elbow, medial collateral ligament, Tommy John surgery, throwing athletes, baseball pitchers, biomechanics, and performance. To be included, studies must have evaluated baseball players at any level who underwent UCLR (primary or revision) and assessed RTP and/or competitive outcomes.
A total of 29 studies with relatively high methodological quality met the inclusion criteria. After primary UCLR, Major League Baseball (MLB) pitchers returned to play in 80% to 97% of cases in approximately 12 months; however, return to the same level of play (RTSP) was less frequent and took longer, with 67% to 87% of MLB pitchers returning in about 15 months. RTP rates for MLB pitchers after revision UCLR were slightly lower, ranging from 77% to 85%, while RTSP rates ranged from 55% to 78%. RTP rates for catchers (59%-80%) were generally lower than RTP rates for infielders (76%) and outfielders (89%). All studies found a decrease in pitching workloads after UCLR. Fastball usage may also decrease after UCLR. Changes in earned run average and walks plus hits per inning pitched were inconclusive.
Pitchers returned to play after UCLR in approximately 12 months and generally took longer to return to their same level of play. Pitchers also returned to play less frequently after revision UCLR. After both primary and revision UCLR, professional pitchers experienced decreased workloads and potentially decreased fastball usage as well. Catchers may RTP after UCLR less frequently than pitchers, infielders, and outfielders possibly because of the frequency of throwing in the position. These results will help guide clinical decision making and patient education when treating UCL tears in baseball players.
尺侧副韧带（UCL）重建术（UCLR）在棒球运动中非常常见。然而，尚无综述比较初次和翻修UCLR后投手以及UCLR后内场手的重返赛场（RTP）情况和比赛中的表现统计数据。
回顾、综合并评估已发表的关于棒球运动员UCLR后结局的文献，以确定不同群体棒球运动员的RTP和比赛结局。
系统综述；证据等级，4级。
进行文献检索，查找1980年至2019年11月4日期间包含以下术语的文章：尺侧副韧带、肘部、内侧副韧带、汤米·约翰手术、投掷运动员、棒球投手、生物力学和表现。纳入的研究必须评估了接受UCLR（初次或翻修）的任何水平的棒球运动员，并评估了RTP和/或比赛结局。
共有29项方法学质量相对较高的研究符合纳入标准。初次UCLR后，美国职业棒球大联盟（MLB）投手约12个月内80%至97%的病例重返赛场；然而，回到相同比赛水平（RTSP）的频率较低且所需时间更长，约15个月内67%至87%的MLB投手重返赛场。翻修UCLR后MLB投手的RTP率略低，为77%至85%，而RTSP率为55%至78%。接球手的RTP率（59% - 80%）通常低于内场手（76%）和外场手（89%）。所有研究均发现UCLR后投球工作量减少。UCLR后快球使用率也可能降低。自责分率和每局投球中保送加安打的变化尚无定论。
投手在UCLR后约12个月重返赛场，通常需要更长时间回到相同比赛水平。翻修UCLR后投手重返赛场的频率也较低。初次和翻修UCLR后，职业投手的工作量均减少，快球使用率也可能降低。接球手UCLR后重返赛场的频率可能低于投手、内场手和外场手，可能是因为该位置的投掷频率。这些结果将有助于指导治疗棒球运动员UCL撕裂时的临床决策和患者教育。
