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Tommy John Surgery: Most Able to Return to Mound

85% return to pre-injury level of performance after surgery, 9 to 12 months of rehabilitation

More than 8 out of 10 of high school and collegiate pitchers undergoing so-called Tommy John elbow reconstructive surgery are able to return to their pre-injury level of performance after 9 months to a year of rehabilitation, a recent study (Hechtman KS, 2011) finds.Pitcher in windup

Injuries to the ulnar collateral ligament (UCL) of the elbow, either as a result of an acute traumatic rupture or repeated stress to the elbow resulting in gradual stretching and eventual rupture of the ligament, are common among throwing athletes and often significantly impair their performance due to the instability, pain and inability to perform overhand throwing activities.  Because nonoperative treatment (rest, immobilization and non-steroidal anti-inflammatory medications) is successful in only 4 out of 10 patients (42%), reconstruction of the UCL may be required to allow the athlete to return to his or her previous level of performance.

Reviewing the results for 34 baseball pitchers (20 collegiate, 14 high school) who underwent UCL reconstruction over a 6-year period from 1997 to 2002, researchers found that 29 of 34 (85%) were able to return to competition at or above their preinjury level of participation following a standardized rehabiliation protocol in which most patients were able to begin a throwing program by the fourth month, were at 50% of their preoperative velocity by the sixth postoperative month, and were progressed over the next few months in the number of throws and velocity, with all reaching 100% by 9 to 12 months. 

May 10, 2014 update:  a more recent study (Bruce JR, 2014) found that the rates on return to play after Tommy John surgery were different for high school pitchers and those at the collegiate and professional level, with adolescent athletes in the 14 to 16 year old age group experiencing a 75% rate return to pitching after UCL reconstruction surgery versus 85% for the 18 and over age group.  According to lead author, Jeremy Bruce, MD, an orthopaedic surgeon specializing in sports medicine and a clinical instructor at The University of Tennessee's College of Medicine Chattanooga, it is unknown "whether it is the lack of appropriate post-injury rehabilitation or the loss of interest after having to take a year away from the sport" which contributes to the lower percentage of return.


Sources: 

American Academy of Orthopaedic Surgeons (http://newsroom.aaos.org/media-resources/Press-releases/throwing-injurie...

Bruce JR, Andrews JR. Ulnar Collateral Ligament Injuries in the Throwing Athlete. J Am Acad Orthop Surg. 2014;22(5):315-325. doi: 10.5435/JAAOS-22-05-315

Hechtman KS, Zvijac JE, Wells ME, Botto-van Bemden A. Long-Term Results of Ulnar Ligament Reconstruction in Throwing Athletes Based on Hybrid Technique. Am J Sports Med. 2011;39(2): 342-347.

 

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