Acute ruptures of the ulnar collateral ligament (UCL) of the thumb are common among elite athletes raising questions about the efficacy of surgical repair to get the athletes back on the field.

To find out about return to sports rates and performance level after surgery, Patrick C. McCulloch, M.D., a Houston Methodist orthopedic surgeon, and colleagues analyzed data from Major League Baseball (MLB) players who underwent thumb ulnar collateral ligament repair in their study, “Performance and Return-to-Sport after Thumb Ulnar Collateral Ligament Repair in Major League Baseball Players,” which was published in the January 2018 issue of the Orthopaedic Journal of Sports Medicine.

Data was collected on Major League Baseball (MLB) players who underwent thumb UCL surgery from August 3, 1987 to September 6, 2016. Both demographic and performance data were collected on each player and return to sport in MLB was defined as playing in at least one MLB game after surgery. These players were compared to matched controls.

In this study, 21 players were identified. They had a mean age of 31.7 ± 3.9 years and a mean experience in the MLB of 8.6 ± 3.3 years. All 21 players achieved return to sport at a mean 120.0 ± 75.9 days.

Overall, McCulloch and colleagues did not find any significant decrease in games per season or career length for any position following surgery. In addition, they didn’t find any different in performance level between players who had surgery on their dominant hand and those who had surgery on their nondominant hand, the hand that wears the glove.

They did notice that infielders had a lower rate of postoperative wins above replacement (WAR) than they did preoperatively (p = .06). When these players were compared to the matched controls, however, no significance differences were found.

McCulloch told OTW that this may represent a natural decline in players as they age.

He said the biggest takeaway from the study was that “players who underwent thumb UCL repair played in a similar number games per season and had similar career lengths in the MLB as controls.”

He added, “There were no significant postoperative performance score differences when compared to post-index matched controls.”

McCulloch did acknowledge certain limitations to the study including multiple unknown confounding variables like no direct physical contact or medical records as well as the heterogeneity of surgeons, surgeon skill and surgical technique.

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