SciCombinator

Discover the most talked about and latest scientific content & concepts.

Concept: Tommy John surgery

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BACKGROUND:Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on Major League Baseball (MLB) pitchers in the United States. PURPOSE:To determine (1) the rate of return to pitching (RTP) in the MLB after UCL reconstruction, (2) the RTP rate in either the MLB and minor league combined, (3) performance after RTP, and (4) the difference in the RTP rate and performance between pitchers who underwent UCL reconstruction and matched controls without UCL injuries. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Major League Baseball pitchers with symptomatic medial UCL deficiency who underwent UCL reconstruction were evaluated. All player, elbow, and surgical demographic data were analyzed. Controls matched by age, body mass index, position, handedness, and MLB experience and performance were selected from the MLB during the same years as those undergoing UCL reconstruction. An “index year” was designated for controls, analogous to the UCL reconstruction year in cases. Return to pitching and performance measures in the MLB were compared between cases and controls. Student t tests were performed for analysis of within-group and between-group variables, respectively. RESULTS:A total of 179 pitchers with UCL tears who underwent reconstruction met the inclusion criteria and were analyzed. Of these, 148 pitchers (83%) were able to RTP in the MLB, and 174 pitchers were able to RTP in the MLB and minor league combined (97.2%), while only 5 pitchers (2.8%) were never able to RTP in either the MLB or minor league. Pitchers returned to the MLB at a mean 20.5 ± 9.72 months after UCL reconstruction. The length of career in the MLB after UCL reconstruction was 3.9 ± 2.84 years, although 56 of these patients were still currently actively pitching in the MLB at the start of the 2013 season. The revision rate was 3.9%. In the year before UCL reconstruction, pitching performance declined significantly in the cases versus controls in the number of innings pitched, games played, and wins and the winning percentage (P < .05). After surgery, pitchers showed significantly improved performance versus before surgery (fewer losses, a lower losing percentage, lower earned run average [ERA], threw fewer walks, and allowed fewer hits, runs, and home runs) (P < .05). Comparisons between cases and controls for the time frame after UCL reconstruction (cases) or the index year (controls) demonstrated that cases had significantly (P < .05) fewer losses per season and a lower losing percentage. In addition, cases had a significantly lower ERA and allowed fewer walks and hits per inning pitched. CONCLUSION:There is a high rate of RTP in professional baseball after UCL reconstruction. Performance declined before surgery and improved after surgery. When compared with demographic-matched controls, patients who underwent UCL reconstruction had better results in multiple performance measures. Reconstruction of the UCL allows for a predictable and successful return to the MLB.

Concepts: Baseball, Baseball statistics, Major League Baseball, National League, St. Louis Cardinals, Minor league baseball, Designated hitter, Tommy John surgery

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Baseball pitching imposes a dangerous valgus load on the elbow that puts the joint at severe risk for injury. The goal of this study was to develop a musculoskeletal modeling approach to enable evaluation of muscle-tendon contributions to mitigating elbow injury risk in pitching. We implemented a forward dynamic simulation framework that used a scaled biomechanical model to reproduce a pitching motion recorded from a high school pitcher. The medial elbow muscles generated substantial, protective, varus elbow moments in our simulations. For our subject, the triceps generated large varus moments at the time of peak valgus loading; varus moments generated by the flexor digitorum superficialis were larger, but occurred later in the motion. Increasing muscle-tendon force output, either by augmenting parameters associated with strength and power or by increasing activation levels, decreased the load on the ulnar collateral ligament. Published methods have not previously quantified the biomechanics of elbow muscles during pitching. This simulation study represents a critical advancement in the study of baseball pitching and highlights the utility of simulation techniques in the study of this difficult problem.

Concepts: Simulation, Baseball, Pitcher, Fastball, Catcher, Baseball positions, Tommy John surgery, Relief pitcher

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While the high rate of ulnar collateral ligament (UCL) injuries in professional baseball is widely discussed in the media and medical literature, the actual prevalence of UCL reconstruction has not been documented.

Concepts: Medicine, Surgery, Art, Major League Baseball, Minor league baseball, Nippon Professional Baseball, Tommy John surgery, Israel Baseball League

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Recent reports have highlighted the progressive increase in the incidence of ulnar collateral ligament (UCL) injuries to the elbow in baseball players of all levels. However, knowledge of the incidence and other epidemiological factors regarding UCL injuries, specifically in college baseball players, is currently lacking.

Concepts: Major League Baseball, Designated hitter, Tommy John surgery, College World Series

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The number of ulnar collateral ligament (UCL) reconstructions being performed has risen sharply in recent years, most notably in the young amateur athlete. While successful outcomes have been reported with reconstruction, the surgery and the associated rehabilitation timeline may be difficult for the nonelite athlete to incur. Return-to-play expectations, along with level of competition, should help guide surgeons in exploring management options. While reconstruction remains a mainstay, focused research exploring nonreconstructive options has expanded. This review discusses the clinical approach to those with UCL injury, including current support for rehabilitation, biologic strategies, and available repair or augmentation alternatives.

Concepts: Surgery, Tommy John surgery

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The patient was an 18-year-old collegiate baseball pitcher who injured his right throwing elbow during an overhead slider pitch. As a part of a study, preinjury ultrasound images of the throwing arm were obtained 2 weeks prior to the injury. One day postinjury, repeat ultrasound imaging of the medial elbow was performed. The attending team physician ordered a magnetic resonance arthrogram 2 days after injury, which confirmed the presence of a complete tear of the ulnar collateral ligament. J Orthop Sports Phys Ther 2016;46(12):1086. doi:10.2519/jospt.2016.0420.

Concepts: Pitch, Baseball, Pitcher, Fastball, Catcher, Slider, Tommy John surgery

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The ulnar collateral ligament (UCL) is a vital structure to the overhead athlete, especially the baseball pitcher. For reasons not completely understood, UCL injuries have become increasingly more common in major league baseball (MLB) pitchers over the past 10 years. UCL reconstruction (UCLR) is the current gold standard of treatment for these injuries in MLB pitchers who wish to return to sport (RTS) at a high level and who have failed a course of non-operative treatment. Results following UCLR in MLB pitchers have been encouraging, with multiple RTS rates now cited at greater than 80%. Unfortunately, with the rising number of UCLR, there has also been a spike in the number of revision UCLR in MLB pitchers. Similar to primary UCLR, the etiology of the increase in revision UCLR, aside from an increase in the number of pitchers who have undergone a primary UCLR, remains elusive. The current literature has attempted to address several questions including those surrounding surgical technique (method of exposure, graft choice, management of the ulnar nerve, concomitant elbow arthroscopy, etc.), post-operative rehabilitation strategies, and timing of RTS following UCLR. While some questions have been answered, many remain unknown. The literature surrounding UCLR in MLB pitchers will be reviewed, and future directions regarding this injury in these high level athletes will be discussed.

Concepts: Baseball, Pitcher, Catcher, Major League Baseball, National League, American League, Designated hitter, Tommy John surgery

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Injury to the ulnar collateral ligament (UCL) often results in valgus elbow instability requiring reconstruction. No standardized and validated outcome measure has compared outcomes between surgical techniques and institutions in the overhead throwing athlete. The aim of this study was to use the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score (KJOC score) to report functional outcomes in overhead throwing athletes undergoing UCL reconstruction. We predict that the KJOC score in our general throwing population will provide an accurate assessment of postoperative outcomes consistent with previously published reports.

Concepts: Surgery, Retrospective, Humerus, Report, Psychometrics, Outcome, Tommy John surgery

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The prevalence of medial ulnar collateral ligament (UCL) reconstruction is increasing in professional athletes and the delivery of baseball news by the media exerts a powerful influence on public opinion of the injury and surgery. The purpose of this investigation was to examine the media’s perception regarding the causes of UCL injury as well as the indications, risks, benefits, and rehabilitation related to UCL reconstruction.

Concepts: Surgery, Information, Tommy John surgery, Tommy John, Ulnar collateral ligament

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The prevalence of medial ulnar collateral ligament (UCL) reconstruction is increasing in professional athletes and the delivery of baseball news by the media exerts a powerful influence on public opinion of the injury and surgery. The purpose of this investigation was to examine the media’s perception regarding the causes of UCL injury as well as the indications, risks, benefits, and rehabilitation related to UCL reconstruction.

Concepts: Surgery, Information, Tommy John surgery, Tommy John, Ulnar collateral ligament