Return to Pitching After Tommy John Surgery: Letter to the Editor

Dear Editor:

We would like to comment on the well-written and thoughtful article by Erickson et al ¹ entitled “Rate of Return to Pitching and Performance After Tommy John Surgery in Major League Baseball Pitchers,” published online in AJSM in December 2013. We recognized a similar objective of their study to that of our recent article, entitled “Performance, Return to Competition, and Reinjury After Tommy John Surgery in Major League Baseball: A Review of 147 cases.” ²

Despite similar study cohorts, each study had a different conclusion. Erickson et al concluded that performance in pitchers following Tommy John surgery was improved when compared to prior to surgery, as well as when compared to control players not undergoing Tommy John surgery. In contrast, our study reported a decline in performance among these pitchers following Tommy John surgery, and that this decline in performance was similar to that found in control pitchers over a corresponding time period.

These different outcomes may be due to variations in methodology between the two studies. There was a slight difference in type of outcome reported, such as reporting of wins and losses by Erickson et al and reporting of fastball velocity and pitches thrown in the strike zone by Makhni et al. Also, the study by Erickson et al incorporated a cohort of pitchers that appeared in at least 1 Major League Baseball game before and after surgery, while the study by Makhni et al focused on players who appeared in 10 or more games before and after surgery. Finally, there were differences in matching of Tommy John players with control players that could have also contributed to the difference in performance outcomes.

We would be very interested in any comments by Drs Erickson, Gupta, Harris, Bush-Joseph, Bach, Abrams, San Juan, Cole, and Romeo on the different conclusions between the two studies.