1. UCL Surgery: 3 New Epidemiological Studies
Stan Conte, PT, DPT, ATC
Conte Injury Analytics
Conteinjuryantalytics.com

2. Epidemiology of Ulnar Collateral Ligament Reconstruction in Major and Minor League Baseball Pitchers: Comprehensive Report of 1,429 Cases.
Christopher L. Camp, MD,
Stan Conte, DPT, ATC,
John D’Angelo, BS ,
Stephen A. Fealy, MD
Submitted for Publication

3. Demographics- Comparison Studies
Sample Size

4. Demographics
Sample Size
Professional Level

5. Demographics Sample Size Professional Pitchers Sources of Data
Revisions
Camp, et al, Uses 3 different sources to collect data including HITS.
Years of Data: 47 versus 27 (Erickson)
Study
Surgeries
Pro
MLB
MiLB
Revisions
Year of Study
Sources
Camp
1429
490
939
95 (6.7%)
HITS, Heatmaps, Web
Cain
1281
320 45
188
9 (1%)
Single Institution
Erickson
179
7 (3.9%)
HITS, Web
Makhani
147 NR
BP, Heatmaps

6. Incidence-Is the Epidemic Continuing?

7. Incidence-Minor League Increases?

8. At what age do Professional Pitcher undergo UCL surgery?
Age at Time of Surgery N
Mean (SD)
Range
Median
All Pitchers
1,429
24.4 (4.1)
16.5 to 48.0
23.6
MLB
490
27.5 (3.9)
20.6 to 48.0
26.8
MiLB
939
22.8 (3.2)
16.5 to 36.2
22.4
Primary UCL
1,334
24.2 (4.0)
23.5
Revision UCL 95
27.3 (4.5)
18.8 to 40.4
26.3

9. Once a Pro, What is Average time to TJS?
MLB Pitchers = 7.4 years with Median of 6.5 years
Minor Leagues average 3.0 years in pro’s prior to TJS with Median of 2.2 years.
All Primary UCL surgeries = 4.3 years
Revisions average over 7 years.
Time from start of professional career to surgery N
Mean (SD)
Range
Median
All Pitchers
1,429
4.6 (5.2)
0 to 26.5
3.5
MLB
490
7.4 (3.8)
6.5
MiLB
939
3.0 (2.7)
0 to 18.2
2.2
Primary UCL
1,334
4.3 (3.6)
3.3
Revision UCL 95
7.1 (4.8)
1.0 to 19.9
6.1

10. Overall Survivorship (years)*
Survivorship: How long do they last? Overall survivorship defined as length of time free from revision and still playing at any professional level
Overall Survivorship (years)* N
Mean (SD)
Range
Median
All Pitchers
949
3.8 (3.4)
0 to 22 3
MLB
367
4.8 (3.2)
0 to 18 4
MiLB
582
3.2 (3.3) 2
Primary UCL
881
3.9 (3.4)
Revision UCL 68
2.9 (2.8)
0 to 14
MLB = 4.8 years
MiLB = 3.2 years
Primary Repair = 3.9 years
Revision = 2.9 years

11. Length of Career after TJS
Length of Career in Seasons** N
Mean (SD)
Range
Median
All Pitchers
947
8.8 (5.1)
0.8 to 28.5
7.8
MLB
366
12.5 (4.5)
1.1 to 28.5
11.9
MiLB
581
6.5 (3.9)
0.8 to 25.0
5.6
Primary UCL
879
8.7 (5.0)
7.7
Revision UCL 68
10.8 (5.5)
1.1 to 23.3
10.3
MLB Pitchers = 12.5 seasons
MiLB Pitchers = 6.5 seasons
Primary UCL’s = 8.7 seasons
Revisions = 10.8 seasons

12. Return to Play Any Level Prior Level MLB: 94% (Erickson, et al)
Percentage Able to Return to Any Level %
Diff
p-value
MLB
94.60%
15.60%
<0.001
MiLB
79.00%
Primary Surgery
83.90%
3.20%
0.477
Revision Surgery
80.70%
Percentage Able to Return to Prior Professional Level
80.00%
10.90%
0.004
69.10%
73.40%
9.90%
0.145
Any Level
MLB: 94% (Erickson, et al)
MiLB: Only 79%
Primary Surgeries Only: 83%
Revisions: 81%
Prior Level
MLB: 80%
MiLB: Only 69%
Primary Surgeries: 73%

13. Time to Return to Play-Pitchers
Overall: 14.5; 16.8 months
MLB Only: 14.4; 18.0 Months
MiLB Only: 14.6; 16.3 Months
Primary Only: 14.4; 16.9 Months
Revisions Only: 15.5; Months

14. Time (days) Between Primary and Revision Surgery
Revision Surgery*
Time (days) Between Primary and Revision Surgery N
(%)
p-value
Mean (SD)
Range
Median
All Pitchers 95
(6.7%)
1,413 (1,089)
177 to 4,735
1,085
MLB 46
(9.4%)
0.004
1,816 (1,203)
1,417
MiLB 49
(5.2%)
1,034 (813)
317 to 3,801
693

15. Following Ulnar Collateral Ligament Reconstruction, Professional Baseball Position Players Return to Play Faster but Less Frequently than Professional Pitchers
Christopher L. Camp, MD, Stan Conte, DPT, ATC, John D’Angelo, BS. Stephen Fealy, MD Submitted for Publication

16. Demographics: Catchers overrepresented
167 Surgeries
48 MLB (29.3%)
119 MiLB (70.7%)
Catchers: 47 (28.1%)
Infielders: 62 (37.1%)
Outfielders: 58 (34.7%)

17. Incidence-Increased since 1984
Since the first UCL reconstruction was performed in a professional position player in 1984, the annual incidence of all procedures has risen steadily
Statistically significant: (R2=0.626, p<0.001) .

18. Incidence: Increase occurs in Minor Leagues

19. Return to Play-By Position
Percent Able to Return to Play
Overall
Any Level
75.5%
Prior Level
68.8%
Primary Surgery
76.2%
69.3%
Revision Surgery
60.0%
Catchers
58.6%
50.0%
Infielders
75.6%
77.8%
Outfielders
88.9%
74.1%
Overall: Less than for Pitchers
75% (Any Level); 69% (Prior Level)
Revisions with poor RTP
60%
Catcher have worse RTP
59% (Any Level); ; 50% (Prior Level)
Outfielders have best RTP
89% (Prior Level); 74% (Prior Level)

20. Return to Play Time
Time (days) Until Return to Play N
Mean (SD)
Range
Median
Time (days) Until Return to Play at Any Professional Level
Catchers 24
363 (121.6)
191 to 812
342.5
Infielders 34
294 (87.1)
154 to 648
276
Outfielders 35
375 (144.0)
105 to 780
345
Time (days) Until Return to Play at Prior Professional Level 20
423 (215.8)
215 to 1,176
373 31
357 (232.6)
154 to 1,445
297 26
392 (147.0)
205 to 694
357
Surprising Longer RTP Times for all positions than expected.
Infielders the quickest (9.2 Months)
Catchers and Outfielder Longer (11.5 months)

21. Pitchers compared to Position Players

22. Revisions-Position Players
4 Catchers, 3 OF and 1 IF
Revision Rate: Catchers(8.5%): OF (5.2%), IF(1.6%)
Average time from Primary to Revision: 26.6 months
Range was huge (9 months to 94.4 months)
Revision Surgery*
Time (days) Between Primary and Revision Surgery N
(%)
p-value
Mean (SD)
Range
Median
All Position Players 8
(4.8%)
800 (854.3)
272 to 2,840
423
MLB 4
(8.2%)
0.235
1,145 (1,160)
378 to 2,840
682.5
MiLB
(3.4%)
454 (196.7)
272 to 731
405.5
Catchers
(8.5%)
0.245
365 (67.4)
272 to 433
378
Infielders 1
(1.6%)
952 (0)
---
952
Outfielders 3
(5.2%)
1,328 (1,319.0)
413 to 2,840
731
*For revision surgery analysis, only players having their primary surgery prior to surgery 2014 were included.

23. Incidence of Elbow Ulnar Collateral Ligament Surgery in Collegiate Baseball Players
Marcus A. Rothermich, MD Stan A. Conte, PT, DPT, ATC Kyle T. Aune, MPH Glenn S. Fleisig, PhD E. Lyle Cain, Jr., MD Jeffrey R. Dugas, MD Submitted for Publication

24. UCL Surgery increasing in Youth Baseball
Epidemiology of Medial Collateral Ligament Reconstruction: A 10-Year Study of NY State Hodges, Ahmad, et al. AJSM: 2016
Trends in Medial Ulnar Collateral Ligament Reconstruction in the United State: Erickson, Romeo, et al. AJSM. 2015

26. Methods and Design of the Study
Contacted 15 Conferences (52%) and 157 Division 1 Baseball Programs
Picked Conferences with diverse geographical locations
155/157(98.7%) agreed to participate
Online de-ID electronic survey at end of year
155/155 (100%) Programs completed the survey.

27. Surgeries per Program 134 Total UCL Surgeries 0.86/School
Surgery Rate of 2.53% (Total population of 5,295 players)
67 (43%) had NO UCL Surgeries
88 (57%) had at least One Surgery
29 (22%) had more the One.

28. Surgery Demographics Average Age: 19.7 years 86% were Pitchers
Starters (43%); Releivers (57%)
Underclassmen (66%)
Majority of Surgeries performed ”In-Season” (49%)

29. Surgical Procedures Only 99/134 responses on specifics of surgery
Primary UCL Reconstruction: 97%
84% Reconstruction
16% were Primary Repairs with augmentation
4 (3%) were Revisions
36% had Ulnar Never Transpositions

30. Cold Weather versus Warm Weather States
The survey asked where the players had attended high school.
Players were then put in subcategories of Warm and Cold States consistent with other studies.
Incidence was 2.21 for Cold and for Warm.
This was NOT Statistically Significant.

31. Thank You