Outcomes and performance following posteromedial elbow debridement in Major League Baseball players

Background: Overhead athletes are particularly susceptible to elbow valgus extension overload syndrome and development of pathologic changes in the posteromedial elbow. Though arthroscopic debridement/osteophyte resection is frequently performed, few studies have analyzed the outcomes of this procedure and none have specifically addressed professional level athletes. Hypothesis: We hypothesized that following posteromedial elbow debridement, Major League Baseball (MLB) pitchers would exhibit a higher rate of ulnar collateral ligament (UCL) reconstruction than baseline incidence in the existing literature, along with a decline in pitching performance. Methods: Using publicly accessible websites, MLB athletes undergoing posteromedial elbow debridement from 2007 to 2022 were identified. Demographic information, procedure details, return to play (RTP) information, return to the disabled/injured list (DL/IL), subsequent UCL reconstruction, and pitching statistics were analyzed. Pitching performance metrics included earned runs average, walks plus hits per innings pitched, innings pitched, and fastball velocity. Results: A total of 39 MLB players, including 26 pitchers, were included. Within the first three seasons after surgery, 82.1% (n = 32) of players returned to play at the MLB level at a mean time of 176.1 +/- 69 days. Pitchers exhibited a RTP rate of 76.9% (n = 20) at 175.8 +/- 16 days. A total of 38.5% (n = 10) of pitchers returned to the DL/IL for elbow-related issues within three seasons. Subsequent UCL reconstruction was seen only in pitchers, with a frequency of 19.2% (n = 5). No statistically significant differences between single season preoperative/postoperative pitching metrics were identified. A small but significant (P < .05) decrease in fastball velocity (94.4 vs. 92.84; P = .02) was observed over a three-season comparison. Conclusion: Contrary to our hypothesis, this study demonstrates that posteromedial elbow debridement is a viable surgery in MLB athletes, with RTP rate of 82.1% and no increase in rate of UCL reconstruction. Furthermore, there was no significant difference in single season preoperative and postoperative statistical pitching performance. However, over three years postoperatively, there was a 38.5% rate of return to the DL/IL for ongoing elbow ailment and a significant decrease in pitch velocity, raising some concern over the longevity of postoperative improvements. (c) 2024 The Author(s). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).