Ahmad, Christopher S.

Background: Anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for ACL tears to allow baseball players to return to sport (RTS). The optimal graft type and femoral tunnel drilling technique are currently unknown. Hypothesis: There is a high rate of RTS in professional baseball players after ACLR, with no significant difference in RTS rates or performance between cases and controls or between graft types or femoral drilling techniques. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent ACLR between 2010 and 2015 were included. Demographic and performance data (pre- and postoperative) for each player were recorded. Performance metrics were then compared between cases and matched controls. Results: A total of 124 players (mean age, 23.7 ± 4.1 years; 83% minor league players) underwent ACLR. Of these, 80% returned to sport (73% to the same or higher level) at a mean 310 ± 109 days overall and 333 ± 126 days at the same or higher level. The most common graft type was an ipsilateral bone–patellar tendon–bone (BTB) autograft (n = 87; 70%). A total of 91 players underwent concomitant meniscal debridement or repair. No significant difference in any of the primary performance metrics existed from before to after ACLR. Compared with matched controls, no significant difference existed in RTS rates or any performance metrics after ACLR. No significant difference existed in RTS rates or primary performance outcome measures between graft types or femoral drilling techniques. Conclusion: The RTS rate for professional baseball players after ACLR was 80%. No significant difference in performance metrics existed between BTB and hamstring autografts or between femoral drilling techniques. Furthermore, no significant difference in performance or RTS rates existed between cases and matched controls. Femoral drilling technique and graft type did not affect performance and RTS rates in professional baseball players after ACLR.

Background: Ulnar collateral ligament (UCL) reconstruction of the elbow is commonly performed on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. Purpose: To provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Study Design: Case series; Level of evidence, 4. Methods: The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS, and surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play [RTP] rates, RTP times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (docking vs modified Jobe) and graft sources (palmaris longus autograft vs hamstring autograft). Results: A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1424 days (47 months) after their primary surgery. A trend was seen toward increasing numbers of revision surgeries over time ( R 2 = 0.441; P = .104). The most commonly used tunnel configuration was the modified Jobe technique (n = 41; 59.4%), and the most commonly used graft was hamstring autograft (n = 34; 49.3%). A majority (76.6%) of pitchers achieved RTP, and 55.3% were able to return to the same level of play. Mean time to RTP was 436 days (14.5 months) for players with a palmaris longus autograft versus 540 days (18 months) for those with a hamstring autograft ( P = .108). Further, the mean time to RTP was 423 days (14 months) for the docking technique versus 519 days (17 months) for the modified Jobe technique ( P = .296). Similar rates of subsequent injuries and surgeries were noted between the 2 revision techniques and 2 most commonly used graft constructs. Conclusion: Revision UCL reconstruction showed relatively high RTP rates (77%), but only 55% of players returned to their same level of play. Mean time to RTP was shorter than that found in other, smaller investigations. Although general trends were seen toward decreased time to RTP for the docking technique and palmaris longus autograft, these differences did not reach statistical significance.

Background: Hamstring strains are the most common injury for professional baseball players and can result in significant time on the disabled list. To date, no study has reported the current trends in hamstring strains in professional baseball. Hypothesis: Professional baseball players would have an increased incidence of hamstring strains from 2011 through 2016. Study Design: Descriptive epidemiology study. Methods: Injury data were prospectively collected from 2011 through 2016 for every Major League Baseball (MLB) and Minor League Baseball (MiLB) team and was recorded in the MLB Health and Injury Tracking System. Data collected for this study included date of injury, activity during injury, time lost, primary injury or reinjury status, and imaging findings as well as player demographic information related to level of play, age, and position for all hamstring injury events. Injury rates were reported as hamstring injuries per number of games. Results: From 2011 to 2016, there were 2633 hamstring strains in professional baseball players. The rate of hamstring strains increased in MLB from a low of 1 injury every 39 games in 2011 to a high of 1 injury every 30 games in 2016. In MiLB, there were 2192 hamstring strains, with 1 injury every 35 games in 2011 compared with 1 injury every 30 games in 2016. The majority of injuries occurred in the infielder positions (37.5%) and resulted from base running (>50%), most commonly from home to first base. The most common hamstring injury was a grade 2 injury to the distal biceps femoris. The mean time missed after a hamstring injury was 14.5 days. Grade 3 and grade 2 hamstring strains resulted in significantly more days missed compared with grade 1 injuries ( P = .005 and P = .002, respectively). The rate of recurrent hamstring injuries was 16.3% for MLB and 14.2% for MiLB. Recurrent hamstring injuries resulted in more time lost than primary injuries (mean, 16.4 vs 14.5 days, respectively; P = .02). A total of 42 injuries were treated with platelet-rich plasma, and 19 were treated with surgery. The number of injuries treated with platelet-rich plasma increased in successive years. Conclusion: The rate of hamstring strains in professional baseball players has increased over the past 6 years and has resulted in a significant loss of playing time. Study results indicated that these injuries are affected by injury characteristics, position played, running to first base, seasonal timing, and history of hamstring injuries.

Objectives: Ulnar collateral ligament (UCL) reconstruction of the elbow is a commonly performed surgery on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. The purpose of this study is to provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Methods: The Major League Baseball (MLB) Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS while surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play rates, return to play times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (Docking vs. Modified Jobe) and graft sources (palmaris longus autograft vs. hamstring autograft). Results: A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1,424 days (47 months) after their primary surgery. There was a trend toward increasing numbers of revision surgeries over time (R2=0.441; p=0.104). The most commonly used tunnel configuration was the Modified Jobe technique (n=41, 59.4%) and the most common graft utilized was hamstring autograft (n=34, 49.3%). 76.6% of pitchers were able to return to play (RTP) and 55.3% were able to return to the same level of play. Mean time to RTP in players with a palmaris longus autograft was 436 days versus 540 days for hamstring autograft (p=0.108) and the mean time to RTP in players was 423 days for the Docking technique versus 519 days for the Modified Jobe technique (p=0.296). Similar rates of subsequent injuries and surgeries were noted between the two revision techniques and two most commonly used graft constructs. Conclusion: This report detailing revision UCL reconstruction amongst professional baseball pitchers showed a trend towards increasing numbers of revisions being performed, a finding consistent with other recent studies. The overall return to play percentage was higher than previously reported (76.6%); however, significantly fewer (55.3%) players returned to the same level of play. This work also demonstrated decreased return to play times (n=484 days, SD: 117.3) compared to other investigations. The Modified Jobe was the most commonly used surgical technique and the two most commonly used graft constructs were hamstring autograft and palmaris longus autograft. Although this analysis did not reveal any statistically significant comparative differences between surgical techniques or graft constructs, future studies involving head-to-head comparisons of these surgical variables, specific to revision UCL reconstruction, may be helpful in improving player outcomes and career performance.

Background: Professional baseball pitchers are at high risk for tears of the ulnar collateral ligament (UCL) of the elbow, often requiring surgical reconstruction. Despite acceptable published return-to-play outcomes, multiple techniques and graft types have been described. Purpose: This study compares UCL reconstruction (UCLR) outcomes based on tunnel configuration and graft type. Study Design: Cohort study; Level of evidence, 3. Methods: After approval from our institutional review board and Major League Baseball (MLB), 566 professional baseball pitchers who underwent UCLR between 2010 and 2014 were identified and included. The following patient characteristics were analyzed: age, pitching role (starter vs reliever), level of play (MLB vs Minor League Baseball [MiLB]), and throwing side dominance. Surgical factors analyzed included reconstruction technique, graft type, and concomitant procedures. Primary outcome measures consisted of the ability to return to play at any level (RTP), ability to return to the same level of play (RSL), time to return, subsequent elbow injuries, and need for subsequent or revision elbow surgery. The effects of patient and surgical factors on outcomes were analyzed using multivariate linear and logistic regression modeling. Results: The RTP rate was 79.9%, and the RSL rate was 71.2%. Grafts used to reconstruct the UCL included the palmaris longus autograft (n = 361, 63.7%), the gracilis autograft (n = 135, 23.8%), and other grafts (n = 70, 12.5%). Surgical techniques utilized were the docking technique (n = 171, 30.2%), the modified Jobe technique (n = 290, 51.2%), and other techniques (n = 105, 18.6%). There were no significant differences in the time to RTP or RSL based on reconstruction technique or graft type. RTP rates were similar for the docking versus modified Jobe technique (80.1% vs 82.4%, respectively; P = .537) and for the 2 primary graft types (83.1% for palmaris longus vs 80.7% for gracilis; P = .596). The rate of subsequent elbow surgery was 10.5% for the docking technique versus 14.8% for the modified Jobe technique ( P = .203), and the rate of revision UCLR was 2.9% versus 6.2% for the docking versus modified Jobe technique, respectively ( P = .128). Significant trends toward an increasing use of the palmaris longus autograft ( P = .023) and the docking technique ( P = .006) were observed. MLB pitchers were more likely than MiLB pitchers to RTP ( P < .001) and RSL ( P < .001), but they required a longer time to return (mean difference, 35 days; P = .039) and had a higher likelihood of subsequent elbow (odds ratio [OR], 3.58 [95% CI, 2.06-6.23]; P < .001) and forearm injuries (OR, 5.70 [95% CI, 1.99-16.30]; P = .004) but not subsequent elbow surgery. No specific variables correlated with the rates of subsequent elbow surgery or revision UCLR in the multivariate analysis. The use of concomitant ulnar nerve transposition did not affect outcomes. Conclusion: Surgical outcomes in professional baseball players are not significantly influenced by UCLR technique or graft type. There was a high rate (46.3%) of subsequent throwing elbow injuries. MLB pitchers were more likely to RTP and RSL, but they had a higher frequency of subsequent elbow and forearm injuries than MiLB pitchers. Both the docking technique and the palmaris longus autograft are increasing in popularity among surgeons treating professional baseball players.

Objectives: Professional baseball pitchers are at high risk for tears of the ulnar collateral ligament (UCL) of the elbow, often requiring subsequent surgical reconstruction. Despite acceptable published return to play outcomes, multiple techniques and graft types have been described. There is a paucity of clinical data in the current literature comparing UCL reconstruction surgical technique and graft type. Even less is known about the risks for subsequent injury, surgery, or revision UCL reconstruction. Accordingly, this study compares UCL reconstruction outcomes based on tunnel configuration and graft type. Methods: Following approval from our institutional review board and Major League Baseball (MLB), 566 professional baseball pitchers who underwent UCL reconstruction between 2010 and 2014 were identified and included. The following patient demographics were analyzed: age, pitching role (starter vs. reliever), level of play (MLB vs. Minor League Baseball [MiLB]), and throwing side dominance. Surgical factors analyzed included reconstruction technique (Docking vs. Modified Jobe), graft type (palmaris longus autograft vs. gracilis autograft), and concomitant procedures. Primary outcome measures consisted of: the ability to return to play at any level (RTP), to return to the same level of play (RSL), the time to return, subsequent elbow injuries, and the need for subsequent or revision elbow surgery. The impact of the patient and surgical factors on outcomes were analyzed using multivariate linear and logistic regression modeling. Results: The overall RTP was 79.9% and RSL was 71.2%. There were no significant differences in the time to RTP or RSL based on reconstruction technique or graft type. RTP rates were similar for the Docking vs. Modified Jobe techniques (80.1% vs. 82.4%; p=0.537) and for the two primary graft types (83.1% for palmaris vs. 80.7% for gracilis; p=0.596). The risk of subsequent elbow surgery was 10.5% for the Docking Technique vs. 14.8% for the Modified Jobe (p=0.203); and the risk for subsequent UCL revision reconstruction surgery was 2.9% vs. 6.2% for the Docking vs. Modified Jobe Techniques, respectively (p=0.128). Significant trends towards an increasing use of palmaris autograft (p=0.023) and the docking technique (p=0.006) were observed. MLB pitchers were more likely than MiLB pitchers to RTP (p<0.001) and to RSL (p<0.001), but they required a longer time to return (mean difference 35 days; p=0.039), had a higher likelihood of subsequent elbow (OR 3.58; 95% CI 2.055 to 6.231; p<0.001) and forearm injuries (OR 5.695; 95% CI 1.99 to 16.302; p=0.004), but not subsequent elbow surgery. No specific variables were noted to be predictive of subsequent elbow or revision surgery in the multivariate analysis. Conclusion: Surgical outcomes in professional baseball players are not significantly influenced by ulnar collateral ligament reconstruction technique or graft type usage. Major League players are more likely to RTP and RSL, but they have a higher frequency of subsequent elbow and forearm injuries. Both the Docking Technique and palmaris autograft are increasing in popularity amongst surgeons treating professional baseball players.

Background: In recent years, there has been a dramatic rise in the annual number of ulnar collateral ligament (UCL) reconstructions performed in amateur baseball pitchers. Accordingly, increasing numbers of players are entering professional baseball having already undergone the procedure; however, the effect of prior UCL reconstruction on future success remains unknown. Purpose: (1) To provide an epidemiologic report on baseball players who undergo UCL reconstruction before being selected in the Major League Baseball (MLB) Draft, (2) to define the outcomes in terms of statistical performance, and (3) to compare these results with those of matched controls (ie, non–UCL reconstruction). Study Design: Cohort study; Level of evidence, 3. Methods: The MLB Amateur Draft Database was queried to identify all drafted pitchers who underwent UCL reconstruction before being drafted. For each pitcher drafted from 2005 to 2014 with prior UCL reconstruction, 3 healthy controls with no history of elbow surgery were randomly identified for matched analysis. A number of demographic and performance comparisons were made between these groups. Results: A total of 345 pitchers met inclusion criteria. The annual number of pitchers undergoing predraft UCL reconstructions rose steadily from 2005 to 2016 ( P < .001). For matched control analysis, 252 pitchers with a UCL reconstruction and a minimum 2-year follow-up (drafted between 2005 and 2014) were matched to 756 controls (non–UCL reconstruction). As compared with the non–UCL reconstruction group, pitchers who underwent predraft UCL reconstruction reached the MLB level with greater frequency (20% vs 12%, P = .003), and their MLB statistical performances were similar for all measures. Compared with all other pitchers drafted during that period, players who had a predraft UCL reconstruction demonstrated an increased likelihood of reaching progressive levels of play (Full Season A, AA, and MLB) within a given time frame ( P < .05 for all). Conclusion: The number of UCL reconstructions performed in amateur baseball players before the draft increased year over year for the entire study period. Professional pitchers who underwent UCL reconstruction as amateurs appear to perform at least as well as, if not better than, matched controls without elbow surgery.