Limiting Innings Pitched after Tommy John Surgery for MLB Players

With the stakes so high for pitchers in Major League Baseball (MLB), it is critical to get answers regarding one of the most rapidly growing procedures in orthopedics – ulnar collateral ligament reconstruction (UCLR), a.k.a., Tommy John Surgery. To reduce the chances of pitchers having to undergo a revision UCLR, it has been suggested that the number of innings pitched post-operatively in the MLB pitcher’s first season back should be limited. Researchers from Rush University Medical Center have just reported results indicating that this is likely unnecessary.

The physician-scientists, who included Anthony Romeo, M.D., Nikhil Verma, M.D.,?Charles Bush-Joseph, M.D., Bernard Bach, Jr., M.D., Gregory Cvetanovich, and Brandon Erickson, M.D., found that the number of innings pitched and number of pitches thrown in the first full season as well as over a player’s career after UCLR are not associated with an increased risk having to undergo a revision UCLR.

All MLB pitchers between 1974 and 2015 who pitched at least one full season following UCLR were included in the study. They analyzed the recorded pitch counts and innings pitched for the first full season after UCLR, as well as total pitch count and total innings pitched over the pitcher’s entire career. Pitch counts and innings pitched were compared among players who required revision UCLR and those who did not. Of the 154 pitchers in the study, only 19 had to undergo revision UCLR.

Dr. Romeo explains, “Estimates of return to play are eye-opening. Approximately 20% of MLB players will not achieve their pre-injury level of performance following this surgery, and it takes the ones who do return to their pre-injury level of play an average of 15 months or longer to do so. Preventing a second injury to the elbow is critical as revision surgery is much less successful at returning the pitcher to the same level of play. However, it does not appear that instituting limits on the number of innings pitched after a full return to pitching has an impact on preventing revision UCLR surgery.”