Background: The world of professional baseball is demanding, especially for pitchers. Metrics related to pitching performance, player longevity, and the risk of re-injury after Tommy John surgery are crucial concerns but haven’t been thoroughly examined in Major League Baseball (MLB) athletes.
Purpose: This study aimed to investigate the likelihood of MLB pitchers returning to professional baseball after undergoing Tommy John surgery, the rate of re-injury, and any changes in their pitching performance. The initial expectation was that both performance and durability would likely decrease following this surgical procedure.
Study Design: This research employed a cohort study design, categorized as Level of Evidence 3.
Methods: Publicly accessible records from 1999 to 2011 were analyzed to identify all MLB pitchers who had undergone ulnar collateral ligament (UCL) reconstruction, commonly known as Tommy John surgery, at any point during their careers. Pitchers who had undergone multiple Tommy John surgeries were excluded from the study. The research tracked whether each player returned to active MLB competition (playing in at least one game) or became an established player again (playing in ≥10 games), as well as instances of being placed on the disabled list. For established pitchers, a comparison of pitching performance metrics was conducted before and after surgery, and against a control group of pitchers matched by age.
Results: Out of the 147 MLB pitchers included in the study, a significant 80% successfully returned to pitch in at least one Major League Baseball game after Tommy John surgery. However, only 67% of those who were considered established pitchers before surgery managed to return to the same level of consistent competition postoperatively. A concerning 57% of established players were placed on the disabled list again due to subsequent injuries to their throwing arm. Furthermore, the study revealed a decline in pitching performance across several key metrics after surgery when compared to pre-injury levels. These metrics included earned run average (ERA), batting average against (BAA), walks plus hits per inning pitched (WHIP), the percentage of pitches thrown within the strike zone, total innings pitched, the percentage of fastballs thrown, and average fastball velocity (P< .05).
Conclusion: The research indicates that while a return to pitching in professional baseball is common after Tommy John surgery, reinjury and placement on the disabled list remain significant risks for MLB pitchers. Additionally, performance tends to decline in several important pitching metrics after undergoing this procedure. Therefore, it is crucial that patients considering or undergoing Tommy John surgery receive comprehensive counseling regarding the realistic expectations for returning to their pre-injury level of competition and performance.
