Sax Oliver C, Dubin Jeremy, Salem Hytham S, Zummo Joseph, Eaddy Samuel, Ingari John V, Bennett Craig H, Best Matthew J
LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA.
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Orthop. 2025 May 4;64:194-198. doi: 10.1016/j.jor.2025.05.003. eCollection 2025 Jun.
The introduction of ulnar collateral ligament reconstruction (UCLR) (i.e., Tommy John surgery) has revolutionized the management of UCL injury. Many athletes and coaches may perceive surgery to enhance performance, warranting an investigation of the reliability of reporting of outcomes. Multiple studies suggest improved return to sport metrics, but this may be limited by variables examined and sample sizes.
HYPOTHESIS/PURPOSE: We assessed performance metrics in Major League Baseball (MLB) pitchers before and after UCLR in a large publicly available database.
All MLB pitchers who had undergone UCLR between 1983 and 2022 were obtained from a publicly available database: FanGraphs (www.fangraphs.com). Inclusion criteria included: (1) pitchers who appeared in ≥10 MLB games during a single season and (2) a minimum of 24 months follow-up. Exclusion criteria included: non-pitcher position players, minor league players, and prior UCL reconstruction. Data collected included: games played, innings pitched, earned run average (ERA), walks and hits per inning pitched (WHIP), walks per 9 innings (BB/9), strikeouts per 9 innings (K/9), wins above replacement (WAR), and runs above replacement (RAR).
A total of 357 MLB players who had undergone UCLR were identified between 1983 and 2022. There were 276 of 357 players (77.3 %) who returned to play after UCLR. Average WAR (6.99 vs. 4.81, p = 0.04) and RAR (66.84 vs. 46.41, p = 0.04) were greater in the pre-UCLR cohort than post-UCLR cohort, respectively. The average games played, innings pitched, ERA, WHIP, BB/9, K/9, and pitch selection (fastball, slider, cutter, curveball, and changeup) were similar between the cohorts (all p > 0.05). Fastball velocity (mph) were similar between the cohorts (92.3 ± 2.9 vs. 91.5 ± 7.6; p = 0.20).
MLB pitchers returning to playing level after UCLR were found to have decreased WAR and RAR as compared to pre-UCLR, however fastball velocity was similar upon return. Utilizing advanced performance statistics, such as WAR and RAR, provides a more comprehensive view of player performance and works towards improving the reliability of the reporting of outcomes in the literature. These results corroborate the utility of UCLR in return to play and should help guide shared decision making as well as patient/surgeon expectations when considering UCLR.
尺侧副韧带重建术（即汤米·约翰手术）的引入彻底改变了尺侧副韧带损伤的治疗方式。许多运动员和教练可能认为手术能提高运动表现，因此有必要对结果报告的可靠性进行调查。多项研究表明，恢复运动的指标有所改善，但这可能受到所研究变量和样本量的限制。
假设/目的：我们在一个大型公开数据库中评估了美国职业棒球大联盟（MLB）投手在尺侧副韧带重建术前后的表现指标。
1983年至2022年间共确定了357名接受尺侧副韧带重建术的MLB球员。357名球员中有276名（77.3%）在尺侧副韧带重建术后恢复比赛。尺侧副韧带重建术前队列的平均WAR（6.99对4.81，p = 0.04）和RAR（66.84对46.41，p = 0.04）分别高于术后队列。各队列之间的平均比赛场次、投球局数、ERA、WHIP、BB/9、K/9和投球选择（快速球、滑球、卡特球、曲球和变速球）相似（所有p>0.05）。各队列之间的快速球速度（英里/小时）相似（92.3±2.9对91.5±7.6；p = 0.20）。
与尺侧副韧带重建术前相比，尺侧副韧带重建术后恢复到比赛水平的MLB投手的WAR和RAR有所下降，然而恢复后的快速球速度相似。利用WAR和RAR等先进的表现统计数据，可以更全面地了解球员表现，并有助于提高文献中结果报告的可靠性。这些结果证实了尺侧副韧带重建术在恢复比赛中的作用，并应有助于指导共同决策以及患者/外科医生在考虑尺侧副韧带重建术时的期望。
