I just want to say thank you to the AOSSM committee for allowing me to present this and also thank you to my co-authors, many of which are here. Next slide. Our disclosures are all listed on the website. We do not believe that there are any relevant disclosures related to this talk. Next slide. Just a quick background, UCL injury or ulnar collateral ligament injury of the elbow has a significant impact on Major League Baseball pitchers. It's been shown to have a significant loss of time after injury, often upwards of an entire season, and then reports of varying performance after return to play in terms of rate statistics as well as velocity. With this, revision UCL is now increasingly becoming more common. Studies have shown that 25% of MLB pitchers have already undergone a primary UCL reconstruction and similar numbers are seen in professional pitchers at the minor league level. Studies have looked at the effect of a primary UCL reconstruction on velocity. They've shown no differences versus uninjured controlled group. However, there have been differences reported in comparison to the pre-injury level depending on the study. Next slide. MLB installed this system called PitchFX in all stadiums at the end of 2006. This allows for standardized recording of every single MLB pitch that occurs in game play. This includes the pitch type, the velocity, as well as some other factors as well. However, up to this point, no one has utilized this PitchFX system in order to evaluate the fastball velocity or usage rate after revision ulnar collateral ligament reconstruction. Next slide. So our purpose was to evaluate the effect of revision UCLR on MLB pitchers with respect to their postoperative fastball velocity and usage in comparison to their pre-injury season. Our hypotheses were that the postoperative fastball velocity and usage would be significantly decreased versus their pre-revision levels as well as in comparison to a match group of MLB pitchers undergoing a primary UCLR. Next slide. So we utilized the PitchFX system in order to identify all MLB pitchers from 2008 to 2020 or to 2021 who underwent the revision UCLR. We did this using public means, including public databases and injury reports. The timeframe was chosen in order to have a one season of a pre-injury performance year. So the PitchFX system started in 2007. We then collected the fastball velocity and the total fastball usage, which for our purposes was a combination of four seam and two seam fastballs using this system. We collected the pre-injury year as well as the first two years after return and the index year in which the injury was suffered we did not include to avoid any possible subclinical injury. In addition, we found a control group of pitchers undergoing primary UCLR to compare the results versus them as well. Next slide. So you can see here in the flow chart we started with 41 pitchers. There were some exclusions. Some of the pitchers had actually undergone more than two already at that time. We also excluded any pitchers with a primary internal brace procedure to avoid any confounders. Ultimately we were able to show that there was a nearly 80% return to play at the professional level, which was lower in nearly 62% at the MLB level, ultimately leaving us with 21 pitchers available for evaluation. And then in comparison to the group of primary UCLR, you can see that there was no significant difference in age or years of experience. There was also no difference in height, however there was a slight difference in the weight as shown by our analyses. Next slide. So for our results, first we looked at velocity. So in comparison to their pre-revision levels, there was no significant differences in fastball velocities at years one or two after revision UCLR. And then versus a control group of those undergoing primary UCLR, we also did not show a significant difference in fastball velocity at any time after their operation. Next slide. We also looked at fastball usage. So as I said before, this is the combination of four seam and two seam fastballs added together. Versus their pre-revision levels, we showed that there was a significant decrease in their use of fastballs in the first and second years after return in comparison to their pre-revision levels. Versus control groups of those undergoing primary UCLR, there were no significant differences in the fastball percentage at any time point. Next slide. So for our discussion, pitchers that return to the MLB level after revision UCLR can expect to have a similar fastball velocity in comparison to their pre-revision level as well as in comparison to those undergoing a primary UCLR. Of note, there is obviously a limitation there that we were unable to analyze those that were unable to return to the MLB level. So whether they returned to the professional level at the minor league level or if they were not able to return at all, we do not have the ability to analyze them in terms of their fastball velocity or their fastball percentage. And in terms of that, we also show that there is a decrease in fastball usage after they returned from revision UCLR, for which is something I think is very interesting to investigate in the future. As it may suggest that there is less confidence in their fastball and obviously there is much more that goes to or goes into the performance of a pitcher besides just velocity. And MLB continues to increase their available technology and there is now even more data points that we can use to evaluate this in the future as well. Next slide. I just want to say thank you and that's it.

UCL injuries

revision UCL reconstruction

fastball velocity

fastball usage

MLB technology