Return to Pitching After Tommy John Surgery: Response

Authors’ Response:

We thank Drs Gray and Cook for their thoughtful correspondence regarding the recent set of articles examining performance after ulnar collateral ligament (UCL) reconstruction in professional pitchers. These 3 articles, by Drs Erickson, ² Jiang, ³ and our group as well, ⁴ all relied on publicly available pitching metrics in determining overall impact of UCL reconstruction on performance among the most elite of pitchers.

The letter by Drs Gray and Cook highlights a very important aspect of evaluating postoperative performance in mentioning some of the outcomes referenced as performance markers: earned run average (ERA), walks and hits per inning pitched (WHIP), and wins/losses. As noted by Drs Gray and Cook, these metrics are in part dependent on external factors, such as performance of teammates, performance of opponents, and even which type of league the pitcher is playing in (American vs National League).

One motivating reason for using these metrics is that, in the public press, these metrics are indeed used to determine a pitcher’s performance. One major reason for conducting our study was the notion that among the public perception, pitchers undergoing Tommy John surgery often return to improved performance. In fact, we showed in a previous study ¹ that players and coaches alike shared this perception, and anecdotally have met with healthy players who want to undergo this major reconstructive surgery in order to improve their own performance. Therefore, we found it important to use these same metrics in order to highlight the true impact UCL reconstruction has on pitching performance postoperatively. Additionally, in our study, we did try to include certain metrics that were less dependent on “nonpitcher” effects. These metrics included percentage of fastballs thrown, percentage of pitches thrown for strike, and average fastball velocity.

As our data collection continues to evolve, so will our ability to hone in on pure pitching metrics. This will allow us to continue to improve our ability to rate the outcomes of the surgeries we perform, so that we can provide the best counsel to patients being considered for these procedures.