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Do Major League Baseball Team Physicians Harvest the Semitendinosus From the Drive Leg or Landing Leg When Performing Ulnar Collateral Ligament Reconstruction on Elite Baseball Pitchers?

ABSTRACT: Hamstring autograft is a common graft choice when performing ulnar collateral ligament reconstruction (UCLR).The purpose of this study was to survey Major League Baseball (MLB) team physicians and determine whether these physicians harvest the hamstring (semitendinosus or gracilis) from the drive leg (ipsilateral to surgical site) or landing leg (contralateral to surgical site) when performing UCLR on elite-level pitchers. The hypothesis was that the majority of surgeons harvest the hamstring from the drive leg when performing a UCLR.Descriptive epidemiology study.Overall, 52 MLB team orthopaedic surgeons were sent the 5-question online survey. The survey assessed surgeon UCLR volume, surgical technique, which leg the hamstring graft was harvested from, the reasoning for choosing that particular leg, and whether the surgeon would change their practice if evidence showed the hamstring from one of the legs was more important than the other. The survey was sent out 5 separate times to maximize the response rate.Forty (77%) MLB team physicians completed the survey. The largest number of surgeons (n = 16; 40%) performed between 5 and 14 UCLRs annually, while 6 (15%) performed more than 50 UCLRs annually. Most surgeons (n = 23; 57.5%) used the docking technique. Significantly more surgeons harvested the hamstring from the landing leg (n = 29; 72.5%) compared with the drive leg (n = 11; 27.5%) (P = .007). More surgeons cited the reason for their choice of leg as a belief that the hamstring they harvested plays less of a role in the ability of a pitcher to generate a forceful pitch (n = 25; 62.5%) than for logistical reasons in the operating room (n = 15; 37.5%); this difference was not statistically significant. Significantly more surgeons would change their practice (n = 35; 87.5%) if evidence showed the hamstrings from a specific (drive or landing) leg to be more active in the throwing motion compared with those who would not (P < .001).When performing a UCLR using hamstring autograft, the majority of MLB team physicians harvest the hamstring from the landing leg as opposed to the drive leg, as they believe the hamstring from the landing leg plays less of a role in generating a forceful pitch than that from the drive leg.

SUBMITTER: Erickson BJ

PROVIDER: S-EPMC5518968 | biostudies-other | 2017 Jul

REPOSITORIES: biostudies-other

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Project description:BackgroundInjury to the ulnar collateral ligament (UCL) leading to medial elbow instability and possible ulnar neuritis is common in overhead-throwing athletes. Treatment may require UCL reconstruction (UCLR) and concomitant ulnar nerve transposition (UNT) for those with preoperative ulnar neuritis.PurposeTo evaluate the return-to-play (RTP) rates, clinical outcomes, and rates of persistent ulnar neuritis after concomitant UCLR and UNT in a cohort of baseball players with confirmed preoperative ulnar neuritis.Study designCase series; Level of evidence, 4.MethodsEligible patients were those who underwent concomitant UCLR and UNT at a single institution between January 2008 and June 2018 and who had a minimum of 2 years of follow-up. Additional inclusion criteria were athletes who identified as baseball players and who had a confirmed history of ulnar neuritis. Patients were contacted at a minimum of 2 years from surgery and assessed with the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, Andrew-Timmerman (A-T) Elbow Score, Mayo Elbow Performance Score (MEPS), Single Assessment Numeric Evaluation (SANE) score, and a custom RTP questionnaire.ResultsIncluded were 22 male baseball players with a mean age of 18.9 ± 2.1 years (range, 16-25 years). The mean follow-up was 6.1 ± 2.4 years (range, 2.5-11.7 years). Preoperatively, all 22 patients reported ulnar nerve sensory symptoms, while 4 (18.2%) patients reported ulnar nerve motor symptoms. At the final follow-up, 7 (31.8%) patients reported persistent ulnar nerve sensory symptoms, while none of the patients reported persistent ulnar nerve motor symptoms. Overall, 16 (72.7%) players were able to return to competitive play at an average of 11.2 months. The mean postoperative patient-reported outcome scores for the KJOC Shoulder and Elbow Score, MEPS, A-T Elbow Score, and SANE score were 77.9 ± 20.9 (range, 14-100), 92.7 ± 12.7 (range, 45-100), 86.1 ± 17.1 (range, 30-100), and 85.5 ± 14.8 (range, 50-100), respectively.ConclusionThis study demonstrated that after concomitant UCLR and UNT for UCL insufficiency and associated ulnar neuritis, baseball players can expect reasonably high RTP rates and subjective outcomes; however, rates of persistent sensory ulnar neuritis can be as high as 30%.

Project description:Purpose To evaluate and describe the differences in characteristics between the Major League Baseball (MLB) pitchers with greater workload and career longevity in terms of innings pitched (IP) and performance-matched controls who have not experienced similar length careers. Methods Using publicly available data, we identified the top 100 MLB pitchers in terms of career IP. Controls were matched to the top 100 pitchers by draft year and round. Pitchers with fewer than 400 IP were excluded. Demographic information, performance statistics, and injury history were reviewed. Logistic regression analysis and Mann–Whitney U tests were used to compare data. Results Compared with controls, the top 100 pitchers in terms of IP were drafted at a younger age (19.35 vs 19.83, P < .001) and in later rounds (6.16 vs 2.45, P < .001). They made their MLB debut at a younger age (21.77 vs 23.12, P < .001). They also pitched fewer innings before debut (470.59 vs 632.07, P = .007), were older at their first (30.72 vs 27.50 years, P < .001) and second (32.42 vs 29.43 years, P < .001) designations to the injured list (IL), and had a significantly longer time from debut to first (3063.50 vs 1565.59 days, P < .001) and second (3712.10 vs 2202.03 days, P < .001) IL trips. The top 100 pitchers were 7.45 times less likely to have made a trip to the IL within 8 seasons from their debut and were 4.04 times more likely to be younger than 24 years at their major league debut. Conclusions Pitchers with the greatest number of IP in their MLB careers were significantly younger when drafted and when they made their major league debut, although this age difference is likely clinically insignificant. Pitchers who were drafted or debuted at a later age accumulate more pre-debut innings and this may contribute to fewer total IP in the MLB. Similarly, later trips to the injured list and longer duration from debut to first or second trip to the IL, but not total IL trips, are predictive of longer careers compared to age and draft class matched controls. Level of Evidence III, retrospective cohort study.

Project description:BackgroundWeighted-ball throwing programs are commonly used in training baseball pitchers to increase ball velocity. The purpose of this study was to compare kinematics and kinetics among weighted-ball exercises with values from standard pitching (ie, pitching standard 5-oz baseballs from a mound).HypothesisBall and arm velocities would be greater with lighter balls and joint kinetics would be greater with heavier balls.Study designControlled laboratory study.MethodsTwenty-five high school and collegiate baseball pitchers experienced with weighted-ball throwing were tested with an automated motion capture system. Each participant performed 3 trials of 10 different exercises: pitching 4-, 5-, 6-, and 7-oz baseballs from a mound; flat-ground crow hop throws with 4-, 5-, 6-, and 7-oz baseballs; and flat-ground hold exercises with 14- and 32-oz balls. Twenty-six biomechanical parameters were computed for each trial. Data among the 10 exercises were compared with repeated measures analysis of variance and post hoc paired t tests against the standard pitching data.ResultsBall velocity increased as ball mass decreased. There were no differences in arm and trunk velocities between throwing a standard baseball and an underweight baseball (4 oz), while arm and trunk velocities steadily decreased as ball weight increased from 5 to 32 oz. Compared with values pitching from a mound, velocities of the pelvis, shoulder, and ball were increased for flat-ground throws. In general, as ball mass increased arm torques and forces decreased; the exception was elbow flexion torque, which was significantly greater for the flat-ground holds. There were significant differences in body positions when pitching on the mound, flat-ground throws, and holds.ConclusionsWhile ball velocity was greatest throwing underweight baseballs, results from the study did not support the rest of the hypothesis. Kinematics and kinetics were similar between underweight and standard baseballs, while overweight balls correlated with decreased arm forces, torques, and velocities. Increased ball velocity and joint velocities were produced with crow hop throws, likely because of running forward while throwing.Clinical relevanceAs pitching slightly underweight and overweight baseballs produces variations in kinematics without increased arm kinetics, these exercises seem reasonable for training pitchers. As flat-ground throwing produces increased shoulder internal rotation velocity and elbow varus torque, these exercises may be beneficial but may also be stressful and risky. Flat-ground holds with heavy balls should not be viewed as enhancing pitching biomechanics, but rather as hybrid exercises between throwing and resistance training.

Project description:BackgroundFatigue in baseball pitchers is a process linked to lowered physical and mental performance, injury, and changes in kinematics. Numerous studies have associated fatigue with overuse, high ball velocities, lack of rest time, poor mechanics, and degree of self-satisfaction. The aim of this study was to systematically review the literature to identify a theoretical framework for the relationship between outcomes and the manifestation of fatigue on baseball pitching. The synthesized data may identify areas requiring further research.MethodologyThis protocol was registered with PROSPERO (ID: CRD42018114194). SPORTDiscus, Medline, PubMed, Cochrane Database of Systematic Reviews, and Google Scholar were searched, using keywords such as fatigue in pitchers and changes in kinematics (e.g., pitching mechanics, valgus elbow torque), performance (e.g., pitch count, pitch type), and injury (e.g., pain, elbow, and shoulder soreness). Three reviewers independently screened the articles, selected relevant literature based on abstract eligibility, and assessed the methods described therein for final inclusion.ResultsA total of 31,860 articles were screened for eligibility and 25 articles were included for the review. The selected articles included epidemiological, longitudinal, experimental, conference papers, and crossover laboratory studies. Evidence extracted from the 25 studies demonstrates a relationship between fatigue in baseball pitching, and three overarching outcomes: changes in kinematics, a decrease in performance, and an increase in injury risk.ConclusionsFindings show that a co-dependence between changes in kinematics and a decrease in performance, which stems from central and peripheral fatigue, is a contributing factor of injury in baseball pitchers. A large percentage of baseball pitchers exhibit pain or soreness in either their elbow or shoulder, or both at some point in a season. Initially, kinematic changes occur that could maintain performance, but may increase joint and tissue loading. Performance decreased with elevated pitch counts and innings thrown, and pitching further into games or the season. Evidence was found to be consistent across all studies; however, more work is needed in the area of fatigue as an injury mechanism during pitching. With a proof of concept established, the prevention of negative outcomes associated with fatigue must be the focus of future research and performance should not be the only criteria.

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Do Major League Baseball Team Physicians Harvest the Semitendinosus From the Drive Leg or Landing Leg When Performing Ulnar Collateral Ligament Reconstruction on Elite Baseball Pitchers?

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