DOI: 10.1177/23259671261484326 ISSN: 2325-9671

Outcomes of Primary and Revision UCLR: Return to Play, Performance, and Role Adaptation

Hsuan-Hsiao Ma, Wei-Lin Chang, Hung-Yu Chen, Kun-Hui Chen, En-Rung Chiang, Hsiao-Li Ma
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Background:

Ulnar collateral ligament reconstruction (UCLR) is a common procedure among Major League Baseball (MLB) pitchers, but the effects of revision UCLR on performance and career longevity remain unclear.

Purpose:

To compare return-to-play (RTP) and return-to-level (RTL) rates, performance metrics, and role transitions between pitchers undergoing primary and revision UCLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 177 MLB pitchers who underwent primary or revision UCLR between 2015 and 2021 were included. Performance metrics, including fastball velocity, spin rate, fastball usage, fielding independent pitching, and pitch movement, were analyzed up to 3 years postreconstruction (PRY1-PRY3). Role transitions between starter and reliever positions were also evaluated.

Results:

RTP ( P = .046) and RTL ( P = .039) rates were significantly lower after revision UCLR. After stratification by pitcher role, revision starters demonstrated greater increases in fastball usage ( P = .014) and horizontal break ( P = .031) at PRY3, whereas no significant differences were observed among relievers. Revision UCLR remained independently associated with lower RTL, but not with RTP, after multivariable analyses. Starter-to-reliever transitions were common after surgery, with no significant between-group difference.

Conclusion:

This study underscores the importance of recognizing role changes and reduced recovery success in revision cases, as well as the need for tailored strategies to support long-term performance and durability.

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