Rafael Escamilla UCLR Surgery in Pitchers

Biomechanical Performance of Baseball Pitchers With a History of Ulnar Collateral Ligament Reconstruction

Glenn S. Fleisig, Charles E. Leddon, Walter A. Laughlin, Michael G. Ciccotti, Bert R. Mandelbaum, Kyle T. Aune, Rafael F. Escamilla, Toran D. MacLeod and James R. Andrews

Am J Sports Med 2015 43: 1045 originally published online February 17, 2015

Investigation performed at the American Sports Medicine Institute, Birmingham, Alabama, USA

Background: A relatively high number of active professional baseball pitchers have a history of ulnar collateral ligament reconstruction (UCLr) on their throwing elbow. Controversy exists in the literature about whether professional baseball pitchers regain optimal performance after return from UCLr. It has been suggested that pitchers may have different biomechanics after UCLr, but this has not been previously tested.

Hypothesis: It was hypothesized that, compared with a control group without a history of UCLr, professional pitchers with a history of UCLr would have (1) significantly different throwing elbow and shoulder biomechanics; (2) a shortened stride, insufficient trunk forward tilt, and excessive shoulder horizontal adduction, characteristics associated with ‘‘holding back’’ or being tentative; (3) late shoulder rotation; and (4) improper shoulder abduction and trunk lateral tilt.

Study Design: Controlled laboratory study.

Methods: A total of 80 active minor league baseball pitchers (and their 8 Major League Baseball organizations) agreed to participate in this study. Participants included 40 pitchers with a history of UCLr and a matched control group of 40 pitchers with no history of elbow or shoulder surgery. Passive ranges of motion were measured for each pitcher’s elbows and shoulders, and then 23 reflective markers were attached to his body. The pitcher took as many warm-up pitches as desired and then threw 10 full-effort fastballs for data collection. Ball speed was recorded with a radar gun. The reflective markers were tracked with a 10-camera, 240-Hz auto-mated motion analysis system. Eleven biomechanical parameters were computed for each pitch and then averaged for each participant. Demographic, range of motion, and biomechanical parameters were compared between the UCLr group and the control group by use of Student t tests (significance set at P \ .05).

Results: All hypotheses were rejected, as there were no differences in pitching biomechanics between the UCLr group and the control group. There were also no differences in passive range of motion between the 2 groups. Conclusion: Compared with a control group, active professional pitchers with a history of UCLr displayed no significant differences in shoulder and elbow passive range of motion and no significant differences in elbow and shoulder biomechanics.

Clinical Relevance: Clinical studies have previously shown that 10% to 33% of professional pitchers do not return to their pre-injury level; however, the current study showed that those pitchers who successfully return to professional baseball after UCLr pitch with biomechanics similar to that of non-injured professionals.

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