Authors’ Response:
We appreciate Dr Byrd’s interest and inquiry regarding our study. The 2015 report by Byrd and Jones1 was a prospective study that evaluated 41 intercollegiate or Major League Baseball (MLB) players over 12 years, with the purpose of reporting the results of hip arthroscopy over time. The primary outcome measure was the modified Harris Hip Score (mHHS), which was assessed at a follow-up of 24 to 120 months. Compared with preoperative mHHS values, subjects’ postoperative scores demonstrated a mean improvement of 13 points at final follow-up (P < .001). The authors also found that of the 8 MLB pitchers in the study, 6 (75%) underwent ulnar collateral ligament (UCL) surgery in that time.
This is important, as the results of our study support this previously identified notion that UCL and hip injuries, specifically femoroacetabular impingement, may have a connection in elite pitchers. In our report, MLB pitchers who underwent UCL surgery sustained hip injuries within 4 years of their surgery, at a rate of 11% as compared with matched controls at a rate of 4.1% (P = .027).2 Interestingly, in the 6 MLB pitchers in the Byrd and Jones study1 who underwent both hip arthroscopy and UCL reconstruction, hip surgery preceded UCL surgery in only 3 cases. In our study, hip injuries preceded UCL reconstruction at a rate of 11 to 6. Thus, our research stands to further elucidate the acknowledged relationship between UCL and hip injuries; our data add evidence that hip pathology, which impairs range of motion within the kinetic chain of overhand throwing, may predispose to overcompensation at the elbow and ultimately to UCL damage.
David E. Kantrowitz, BS
David P. Trofa, MD
Denzel Woode, BS
Christopher S. Ahmad, MD
T. Sean Lynch, MD
New York, New York, USA
Footnotes
One or more of the authors has declared the following potential conflict of interest or source of funding: C.S.A. receives royalties from Arthrex, is a paid speaker/presenter for Arthrex, and has received hospitality payments from Arthrex and DePuy Synthes. T.S.L. is a paid speaker/presenter for Smith & Nephew, has received educational funding from Arthrex, and has received hospitality payments from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
References
- 1. Byrd JWT, Jones KS. Hip arthroscopy in high-level baseball players. Arthroscopy. 2015;31(8):1507–1510. [DOI] [PubMed] [Google Scholar]
- 2. Kantrowitz DE, Trofa DP, Woode DR, Ahmad CS, Lynch TS. Athletic hip injuries in Major League Baseball pitchers associated with ulnar collateral ligament tears. Orthop J Sports Med. 2018;6(10):23259 67118800704. [DOI] [PMC free article] [PubMed] [Google Scholar]