APPENDIX Table A2.
Studies Included in Assessment of RTP Outcomesa
| Lead Author (Year) | Participants | Outcome Measures | Major Results | STROBE Scoreb |
|---|---|---|---|---|
| Camp5 (2019) | 47 MLB + MiLB pitchers with revision UCLR | RTP rate, time to RTP, RTSP rate, time to RTSP | The overall RTP rate was 76.6%; however, the RTSP rate was only 55.3%. On average, pitchers returned in 484 ± 117.3 d, and those who returned to the same level of participation took 518 ± 158.9 d. | 20 |
| Erickson15 (2016) | 154 MLB pitchers underwent primary UCLR, 19 of whom later required revision UCLR | Revision rate, innings pitched, No. of pitches thrown | Overall, 12% of pitchers required revision UCLR. No significant differences existed in innings pitched in the season after UCLR or No. of pitches thrown in the season after UCLR. Additionally, no differences existed between pitchers needing revision and those not needing revision for innings pitched during the career and No. of pitches thrown during the career after UCLR. | 18 |
| Erickson13 (2017) | 569 professional pitchers with UCLR | Time to RTP, time to RTSP | Time to RTP was not significantly different between the no revision and revision groups (514 ± 225 vs 459 ± 183 d, respectively; P = .148). Time to RTSP was also not significantly different between the no revision and revision groups (554 ± 242 vs 476 ± 149 d, respectively; P = .189). | 19 |
| Jones30 (2013) | 18 MLB pitchers with revision UCLR | RTSP rate, time to RTSP | Overall, 77.8% of the pitchers requiring revision were able to return to the same level within 2 full seasons. Relievers were able to return to MLB approximately 2 mo earlier versus starters (mean time to RTSP, 18.3 vs 19.8 mo, respectively). | 16 |
| Liu37 (2016) | 38 MLB pitchers with revision UCLR | Revision rate, time between index surgery and revision, time between revision and RTP | Since 1999, 13.2% of pitchers undergoing UCLR required revision; 65.4% of MLB pitchers who required revision UCLR were able to return to pitching in at least 1 MLB game; however, only 42.3% were able to return to pitching in ≥10 games after revision. On average, MLB pitchers requiring revision UCLR pitched in 74.7 games over 2.64 seasons. The mean time between index and revision UCLR was 5.02 y. | 20 |
| Marshall43 (2015) | 33 MLB pitchers with revision UCLR | RTP rate, RTSP rate, MLB seasons after revision | The RTP rate after revision was 84.8%, with the RTSP rate being 65.5% after revision. MLB pitchers requiring revision UCLR, on average, competed in 3.2 MLB seasons (4.1 seasons combining MLB + MiLB) after revision. | 21 |
| Erickson14 (2019) | 292 MLB + MiLB pitchers with primary UCLR | RTP rate, time to RTP, RTSP rate, time to RTSP | When comparing autograft types, using a hamstring versus palmaris tendon graft yielded similar RTP rates (72.3% vs 77.4%, respectively) and times to RTP (417.99 ± 162.18 vs 409.22 ± 115.00 d, respectively). Additionally, using hamstring and palmaris tendon autografts demonstrated similar rates of RTSP (61.0% vs 68.7%, respectively) and similar times to RTSP (501.23 ± 230.35 vs 469.53 ± 173.64 d, respectively). | 20 |
| Erickson16 (2014) | MLB pitchers with primary UCLR: 179 for RTP analysis + 148 for competitive analysis | RTP rate, RTSP rate, MLB seasons after primary UCLR | Pitchers undergoing primary UCLR had a 97.2% RTP rate in either MLB or MiLB and an 83.0% RTSP rate. On average, pitchers who returned to any level of baseball competed for 3.89 seasons after UCLR, demonstrating no significant difference when matched with controls. | 22 |
| Ford22 (2016) | 43 players from a single professional baseball organization | RTP rate, RTSP rate | Operatively treated injuries had an 87% RTP rate and a 71% RTSP rate. | 19 |
| Gibson23 (2007) | 68 MLB pitchers with primary UCLR | RTSP rate, time to RTSP | Overall, 82% of reconstructed pitchers were able to return to MLB after UCLR, 94% of whom were able to return to MLB within 3 seasons after UCLR. On average, players returned to MLB in 18.5 mo (range, 10-49mo) after surgery. | 17 |
| Griffith25 (2019) | 566 professional pitchers with primary UCLR | RTP rate, time to RTP, RTSP rate, time to RTSP | Overall, 79.9% of professional pitchers requiring UCLR were able to RTP, with 71.2% being able to RTSP. MLB pitchers were more likely to RTP (P < .001) and RTSP (P < .001) versus MiLB pitchers. RTP took a mean of 436 ± 146 d (range, 168-1643d), and RTSP took a mean of 518 ± 202 d (range, 173-1414d). There were no differences in RTP based on the surgical technique or graft type used. Similarly, there were no differences in RTSP based on technique or graft type. | 19 |
| Jiang28 (2014) | 38 MLB pitchers with primary UCLR | RTP rate, RTSP rate, time to RTSP | Overall, 97% of pitchers were able to RTP after primary UCLR, while 79% were able to return to pitching at the MLB level. For those who returned at the MLB level, it took a mean of 17.1 mo (range, 11-27 mo). | 20 |
| Keller34 (2014) | 168 MLB pitchers with primary UCLR | RTP rate | Overall, 87% of MLB pitchers undergoing primary UCLR were able to return to MLB pitching. Pitchers who were able to RTP noted a decline in performance statistics upon returning. | 19 |
| Makhni39 (2014) | 147 MLB pitchers with primary UCLR | RTP rate, RTSP rate | Of pitchers who pitched in >10 games per season (established) before surgery, only 66% of pitchers were able to RTSP, with only 12% able to return to pitching for 1-10 games per season after surgery. Also, 21% of established pitchers before surgery did not return to MLB play. | 20 |
| Marshall41 (2019) | 46 MLB pitchers with primary UCLR | RTP rate, RTSP rate, time to return | Overall, 96% of pitchers were able to RTP after surgery, with 82% of pitchers able to return to pitching at the MLB level. On average, it took 13.7 mo (range, 10-23 mo) to RTP. | 19 |
| Marshall42 (2018) | 46 MLB pitchers with primary UCLR | RTP rate, RTSP rate, time to return | Overall, 96% of pitchers were able to RTP after surgery, with 82% of pitchers able to return to pitching at the MLB level. On average, it took 13.7 mo (range, 10-23mo) to RTP. Pitchers were able to compete for a mean of 3.2 y in MLB and 4.6 y total after UCLR. | 21 |
| Begly2 (2018) | 26 MLB position players with primary UCLR | RTSP rate | The overall RTP rate was 80%. For infield players, 90% were able to return to MLB play. For outfield players, 87.5% were able to return to MLB play. However, for catchers, only 56% were able to return to MLB play. | 20 |
| Camp3 (2018) | 167 MLB position players with primary UCLR | RTP rate, RTSP rate, time to return | The overall RTP rate after UCLR at any level for all positions was 76.2%. For catchers, 58.6% returned to play at any level, taking a mean of 363 ± 121.6 d. Only 50.0% of catchers returned to the MLB level, taking a mean of 423 ± 215.8 d. For infielders, 75.6% were able to RTP at any level, taking a mean of 294 ± 87.1 d. Additionally, 77.8% of infielders were able to return to the MLB level, taking a mean of 357 ± 232.6 d. For outfielders, 88.9% were able to return at any level, taking a mean of 375 ± 144.0 d. Moreover, 74.1% of outfielders were able to return to MLB play, taking a mean of 392 ± 147.0 d. Catchers undergoing UCLR were less likely to RTP or RTSP compared with outfielders and infielders. | 15 |
| Jack27 (2018) | 33 MLB position players with primary UCLR | RTSP rate, time to return, age | Overall, 84.8% of position players were able to RTP at the MLB level, taking a mean of 336.9 ± 121.8 d after UCLR. Players aged ≥30 y had a 53.3% rate of returning to MLB compared with 89.4% returning to MLB for players aged <30 y (P = .018). Older position players were less likely to RTP at the MLB level compared with younger position players. For catchers, 71.4% were able to return to MLB play at a mean of 280.0 ± 100.2 d. For infielders, 91.7% were able to return to MLB play at a mean of 362.4 ± 144.9 d. For outfielders, 85.7% were able to return to MLB play at a mean of 337.3 ± 107.4 d. Catchers returned to MLB play at a lower rate compared with infield and outfield players. Catchers returned earlier than did infielders and outfielders. | 20 |
| Marshall40 (2018) | 25 professional catchers with primary UCLR | RTP rate, RTSP rate, time to RTSP, years played after injury | Catchers had an overall RTP rate of 80%, taking a mean of 12.9 ± 5.5 mo. Of the catchers able to RTP, 95% were able to RTSP. Catchers undergoing primary UCLR were able to participate for 4.3 ± 2.4 y after their injury. | 19 |
aMiLB, Minor League Baseball; MLB, Major League Baseball; RTP, return to play; RTSP, return to the same level of play; UCLR, ulnar collateral ligament reconstruction.
bScore of a possible 22 points.