Performance-Based Outcomes after Revision Ulnar Collateral Ligament Surgery in Professional Pitchers.

Objective: To compare performance in baseball pitchers before and after revision ulnar collateral ligament (UCL) surgery using performance metrics.

Design: Case series.

Setting: Public online database.

Patients or participants: Players who underwent revision UCL surgery between 2015 and 2021 were identified. Players were included if they were Minor League (MiLB) or Major League (Major League baseball [MLB]) pitchers. Players were excluded if they were not pitchers, if they underwent their revision surgery as an amateur, or if there is no record of their primary reconstruction surgery.

Interventions: Revision UCL surgery (repair or reconstruction).

Main outcome measures: Return to sport (RTS) rate, RTS time, pitch velocity, and pitch spin rate.

Results: Sixty-five pitchers underwent revision UCL surgery. MiLB pitchers had a shorter RTS time after their primary surgery (15.62 vs 20.77 months, P < 0.01) compared with MLB pitchers but similar RTS times after their revision reconstruction (19.64 vs 18.48 months, P = 0.44). There was also no difference in return to play (RTP) rate overall after primary versus revision reconstruction ( P = 1.00). Major League baseball pitchers also had decreased RTS time after primary compared with revision reconstruction (15.62 vs 19.64 months, P < 0.01) but similar RTP rates ( P = 0.28). Finally, MLB pitchers had similar pitch breakdowns, velocities, and spin rates before and after their primary and revision repair or reconstruction.

Conclusions: Both revision UCL repair and reconstruction can return pitchers to preinjury performance levels. Pitchers and teams should be properly counseled on realistic RTP times and postsurgery performance when discussing revision UCL surgeries.