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Outcomes in Revision Tommy John Surgery in Major League Baseball Pitchers

      Introduction

      With the recent rise in number of Tommy John surgeries, a proportionate rise in revisions is expected. However, much is unknown regarding the current revision rate of Tommy John surgery, return to play, and change in performance in Major League Baseball (MLB) pitchers. We sought to determine (1) the current revision rate of Tommy John surgery in MLB pitchers, (2) the likelihood of return to MLB pitching after revision Tommy John Surgery, and (3) the change in performance after Tommy John revision surgery.

      Methods

      Publicly available databases were used to obtain a list of all MLB pitchers who underwent primary and revision Tommy John surgery. Pitching performance was compared pre- and postoperatively for pitchers who returned to greater than or equal to one MLB game following revision surgery to age- and position-matched controls.

      Results

      Since 1999, 235 MLB pitchers underwent Tommy John Surgeries; 31 pitchers (13.2%) underwent revision surgery. 37% underwent revision within 3 years of their index procedure. 26 revisions had more than 2-year follow up; 17 pitchers (65.4%) returned to pitch at least one major league game while only 11 pitchers (42.3%) returned to pitch ten or more games. Of those who returned to MLB competition, the average length of recovery was 20.76 months. Compared to age- and position-matched controls, MLB pitchers undergoing revision surgery had a statistically shorter career following revision surgery (4.9 vs 2.6 seasons, p = 0.002), and pitched fewer innings and total pitches per season.

      Conclusion

      The rate of revision Tommy John surgery is substantially higher than previously reported. For MLB pitchers, return to play after revision surgery is much lower than after primary reconstruction. Overall, the durability of MLB pitchers following revision UCL reconstruction decreases significantly compared to age- and position-matched controls.