200: Annotated Bibliography
Erickson, B. J., Harris,
J. D., Tetreault, M., Bush-Joseph, C., Cohen, M., Romeo, A. A. (2014). Is Tommy
John Surgery Performed More Frequently in Major League Baseball Pitchers from
Warm Weather Areas? Orthopedic Journal of Sports Medicine.
surgeries in 247 Major League Baseball pitchers from 2014 were identified and analyzed.
The purpose of this study was to determine whether the portion of MLB pitchers
who underwent UCL reconstruction surgery that pitched competitively as a youth
in warm weather areas is higher than those pitchers who are from cold weather
areas. The state/country where each individual played high school baseball was
identified. The latitude distances from the equator and annual temperature mean
defined whether they were from cold or warm weather areas. To compare the
proportion of MLB pitchers who underwent UCL reconstruction from warm to cold
weather areas, a chi-square test was used. Throughout the history of MLB, 64.5%
of all players were from cold weather areas, whereas 35.5% of players were from
warm weather areas. Of the 247 pitchers who underwent UCL reconstruction, 139
(56.3%) were from warm weather areas and 108 (43.7%) were from cold weather
areas. A significantly larger number of pitchers from warmer areas compared to
colder areas underwent this surgery. Within these results, changes in residency
during high school years and previous injuries were not noted which could cause
some implications in the findings.
Ahmad, C. S., Grantham,
J. W., Greiwe, M. R. (2015). Public Perception of Tommy John Surgery. The Physician and Sports Medicine.
A questionnaire distributed
to 189 players, 25 coaches, and 31 parents from 2015 was analyzed. The purpose
of this study was to measure the public’s perception of Tommy John Surgery with
regard to indications, operative technique, risks, recovery time, and benefits.
After analyzing the results of the questionnaire, it will be determined if the
perception of what the public thinks about Tommy John Surgery is correct or
not. The questionnaires were given to individuals through a one on one
interview or through the mail after consent was given. Data was collected from
the questionnaires and a statistical analysis was performed from the results.
52% of high school athletes, 26% of college athletes, 30% of coaches, and 37%
of parents believe that Tommy John surgery should be performed on players
without any elbow injury because they believe it will enhance their
performance. 28% of players, 25% of parents, and 31% of coaches believe pitch
count is not a risk factor and 29% of players, 25% of parents, and 38% of
coaches do not relate the type of pitches thrown to the injury. Many players
and coaches, 28% and 20%, believe that an individual’s performance would be
greater post-surgery compared to pre-surgery. Players (24%), coaches (20%), and
parents (44%) also believe that the time of recovery would be less than 9
months. The percentages show that the perception the public has of Tommy John
Surgery is incorrect.
Makhni, E. C., Lee, R.
W., Morrow, Z. S., Gualtieri, A. P., Gorroochum, P., & Ahmad, C. S. (2014).
Performance, Return to Competition, and Reinjury After Tommy John Surgery in
Major League Baseball Pitchers. The American Journal of Sports Medicine.
surgery of 147 Major League Baseball pitchers from 1999 to 2011 were observed
and analyzed. The purpose of this study was to determine the change in
performance after surgery, reinjury rate, and the likelihood of a return to
competition in MLB pitchers. Public records of MLB pitchers who received UCL
reconstruction surgery between 1999 to 2011 were retrieved. Other extensive
research such as disabled list placement, pitching performance comparisons of
pre, post-surgery, and pitchers of the same ages who did not receive the
surgery were observed. The results of this study show that 80% of these
pitchers went on to pitch in at least one MLB game again. 67% returned to the
same performance as pre-surgery, while more than half (57%) returned to the
disabled list again because of an arm injury. Overall, performance declined
after surgery compared to pre-surgery in numerous metrics such as earned run
average (ERA), batting average against (BAA), walks and hits per innings
pitched (WHIP), innings pitched (IP), strike percentage (K%), percent of
fastballs thrown (FB%), and velocity of fastball. This study was primarily
based on MLB pitchers, so the outcome may not be the same for pitchers at different
competition levels which could lead to some ramifications in the results.
Marshall, N. E., Keller,
R. A., Lynch, J. R., Bey, M. J., & Moutzouros, V. (2015). Pitching
Performance and Longevity After Revision Ulnar Collateral Ligament
Reconstruction in Major League Baseball Pitchers. The American Journal of Sports Medicine.
reconstruction surgery of 33 MLB pitchers from 2015 was identified and
analyzed. The purpose of this study was to evaluate performance and longevity
in MLB pitchers after receiving revision UCL reconstruction surgery. These 33
MLB pitchers were compared to other MLB pitchers of the same age who did not
get the surgery. The evaluation of return to play, statistical performance, and
total years played were observed and compared between the two groups. The
results show that after revision surgery, 65.5% of pitchers returned to the
MLB. They played .08 years less than the other healthy pitchers of the same age
but had a similar ERA and WHIP as them. These results also show that there were
declines in innings pitched, walks, and wins by those who got surgery. After
receiving revision UCL reconstruction, the rate of return to the MLB is low,
but those that return are likely to keep up their same performance with a
decline in their overall workload.
Petty, D. H., Andrews, J.
R., Fleisig, G. S., & Cain, L. E. (2004). Ulnar Collateral Ligament
Reconstruction in High School Baseball Players. The American Journal of Sports Medicine.
Data was collected from
27 former high school baseball players from 2004 and analyzed. The purpose of
this study was to determine if a UCL injury results from overuse, improper
warm-up, throwing at high velocities, and throwing breaking pitches early. Data
on patients follow up examinations and questionnaires were collected from these
players. Risk factors such as overuse, year-round throwing, velocity harder
than 80 mph, breaking pitches being thrown before the age of 14, and
insufficient warm-ups were observed from these individuals. The results show
that 74% of these high school players returned to play baseball at the same
level or higher. Of the six potential risk factors observed, players averaged
at least three of the factors. 67% of the players threw breaking pitches before
the age of 14 years old and the average fastball was reported at 83 mph. Compared
to pitchers at other competition levels, the rate of return for high school
baseball players is about equal. Risk factors such as overuse and breaking
pitches at early ages can contribute to ULC injuries especially if they throw
hard at a young age.
Jiang, J. J., &
Leland, M. J. (2014). Analysis of Pitching Velocity in Major League Baseball
Players Before and After Ulnar Collateral Ligament Reconstruction. The American Journal of Sports Medicine.
surgery of 41 Major League Baseball pitchers from 2008 to 2010 were analyzed. The
purpose of this study was to determine if there would be any significant loss
in the velocity of pitchers in the MLB after UCL reconstruction surgery. Data
criteria of pitch velocity from at least one year before surgery and velocity
data from at least two years post-surgery was collected from these pitchers. 28
pitchers over at least four seasons were analyzed after exclusion criteria were
implemented and they were compared to other MLB pitcher who did not have UCL
injuries. The results show that the average velocity of pitches was about the
same between those who had and did not have UCL reconstruction. The amount of
innings was different for the year that the injury occurred and the first year
back post-injury, but there was no statistical difference in the performance of
the pitchers within the two groups.
Erickson, B. J., Gupta,
A. K., Harris, J. D., Bush-Joseph, C., Bach, B. R., Adams, G. D., . . . Romeo,
A. A. (2013). Rate of Return to Pitching and Performance After Tommy John
Surgery in Major League Baseball Pitchers. The
American Journal of Sports Medicine.
surgery of 179 pitchers in Major League Baseball from 2013 was analyzed. The
purpose of this study was to determine the rate of return to pitching in the
MLB and the performance of each pitcher after undergoing UCL reconstruction. All
players surgical data was observed, and they were compared to other players of
the same age, body mass, position, handedness, experience, and performance.
T-tests were constructed to perform an analysis of variables within and between
the two groups. The results show that of the 179 pitchers who underwent ULC
reconstruction surgery, 174 (97.2%) were able to return to play combined in
both the Major and Minor leagues while 148 (83%) of these pitchers were able to
return to the MLB. Only 5 (2.8%) of the pitchers were not able to return to either
of the leagues. After UCL reconstruction, pitchers returned to the MLB at a
mean of 20.5 months plus or minus 9.72 months. Though there were still 56
pitchers still playing during the time of the study, the career length average
was about 3.9 years plus or minus 2.84 years after surgery. Performance of the
pitchers was down the year before they received UCL reconstruction in total
innings, games and wins compared to after surgery when there was an improvement
in losses, earned run average, walks, runs, and hits. The high percentages show
that UCL reconstruction leads to a high rate of return in the MLB with
performance increasing after surgery in a variety of different measurements.
Erickson, B. J.,
Nwachukwu, B. U., Rosas, S., Schairer, W. W., McCormick, F. M., Bach, Jr., B.
R., . . . Romeo, A. A. (2015). Trends in Medial Ulnar Collateral Ligament
Reconstruction in the United States. The
American Journal of Sports Medicine.
surgeries in 790 patients were performed from 2007 to 2011 and the results were
analyzed. The purpose of this study was to determine the demographics of UCL
reconstruction within the United States population. An analysis of the
PeralDiver database was performed to identify all UCL reconstruction procedures
that took place during this time-period. The results show that of the 790
patients identified, 695 were males and 95 were females. There was an annual
average incidence of 3.96 per 100,000 patients with 22% of these patients being
between the ages of 15 and 19 years old. This age group was the largest percentage
amongst all age groups and increased by an annual percentage of 9.12% each
year. A significant amount of UCL reconstruction surgeries were performed in
the southern part of the US compared to any other part. Over time, the number
of UCL reconstruction surgeries are increasing. These injuries are mainly being
seen in patients between the ages of 15-19 and from individuals who live in the
southern part of the US. The key implications of the results show that the
population that falls into these demographics are the ones who are mainly at
Conte, S. A., Fleisig, G.
S., Dines, J. S., Wilk, K. E., Aune, K. T., Patterson-Flynn, N., &
ElAttrache, N. (2015). Prevalence of Ulnar Collateral Ligament Surgery in
Professional Baseball Players. The American Journal of Sports Medicine.
An online questionnaire
taken by 5088 professional baseball players was collected and analyzed. The
purpose of this survey was to determine the prevalence of UCL reconstruction in
both the Major and Minor leagues. The questionnaire was distributed to all 30
MLB organizations. This includes all players in both the Major and six
different levels of the minor leagues. Demographics were compared between each
level. A t-test was used to compare age, professional years, origin country,
etc. whereas chi-square analysis was used to compare the level of each player,
position, etc. The results show that of these 5088 players, 722 were major
league players and 4366 were minor league players. Pitchers accounted for more
than half of the players who took the survey (53%) and 497 stated that they had
a least one UCL reconstruction. Compared to non-pitchers, pitchers reported a
higher percentage of receiving UCL surgery. 25% of pitchers in the MLB reported
having UCL reconstruction compared to only 15% in the minor leagues. 86% of these
MLB pitches got UCL reconstruction surgery as a professional pitcher whereas
minor league pitchers reported getting surgery in either college or high school
(61%). The key implications of these results are that they can serve as a
baseline for future UCL reconstruction rates based on the perspective that the
numbers provide about the effect it has on these professional baseball players.
Hodgins, J. L., Vitale,
M., Arons, R. R., & Ahmad, C. S. (2016). Epidemiology of Medial Ulnar
Collateral Ligament Reconstruction. The
American Journal of Sports Medicine.
An epidemiology study
on UCL reconstruction was performed in New York State from 2002 to 2011 and was
analyzed. The purpose of this study was to examine trends of a single state
over a period of ten years. The SPARCS database was used to identify all
patients who underwent UCL reconstruction surgery during this ten-year period. Age,
ethnicity, sex, and procedures were examined. The results show that each year
in New York, there was a substantial increase in UCL reconstruction surgeries.
Over the time period, there was an increase by 193% with a large increase in
patients ranging from 17 to 20 years old. Compared to females, males were 11.8
times more likely to receive this surgery. There is a rising epidemic of UCL
reconstruction in New York, especially amongst younger individuals. The key
implications of these results show that public education on the risks th