Tommy John surgery, formally known as ulnar collateral ligament (UCL) reconstruction, is a common yet significant procedure in professional baseball, particularly for pitchers. A key concern for athletes and teams alike is the extent to which pitchers can return to their prior performance levels and remain durable after undergoing this surgery. A recent study investigated these critical aspects among Major League Baseball (MLB) pitchers who underwent Tommy John surgery between 1999 and 2011, shedding light on return rates, reinjury risks, and changes in pitching performance.
This cohort study, utilizing publicly available records, examined 147 MLB pitchers who had UCL reconstruction. The research aimed to determine the percentage of pitchers who successfully returned to professional competition, the incidence of reinjury, and how key performance metrics were affected post-surgery. The initial hypothesis was that both performance and durability would likely decrease after Tommy John surgery.
The findings revealed that while a significant majority, 80%, of the studied pitchers did return to pitch in at least one MLB game, the picture becomes more nuanced when considering established pitchers. Among pitchers who had already established themselves in the league, only 67% managed to return to their previous level of competition after surgery. Furthermore, a concerning 57% of these established pitchers were subsequently placed on the disabled list due to throwing arm injuries. This highlights that even after successful surgery and return to play, the risk of further injury remains substantial.
Beyond return rates and reinjury, the study also analyzed changes in pitching performance metrics. Comparing pre- and post-surgery statistics, as well as against age-matched control pitchers, revealed a decline in several key areas. These included an increase in earned run average (ERA) and batting average against (BAA), and a rise in walks plus hits per inning pitched (WHIP). Pitchers also saw a decrease in the percentage of pitches thrown for strikes, innings pitched, percentage of fastballs thrown, and average fastball velocity. These declines across various performance indicators suggest that Tommy John surgery, while often enabling a return to play, frequently does not restore pitchers to their pre-injury performance levels.
In conclusion, the study underscores that while Tommy John surgery allows a large proportion of MLB pitchers to return to professional baseball, reinjury is a common issue, and performance in key pitching metrics often diminishes post-surgery. Therefore, it is crucial that both pitchers considering Tommy John surgery and the teams supporting them have realistic expectations regarding the likelihood of returning to pre-injury levels of both competition and performance. Appropriate counseling and rehabilitation strategies are essential to optimize outcomes and manage expectations following Tommy John surgery.
