PPAARE question for this article Title of Article: Return$-$to$-$Play and Competitive Outcomes After Ulnar Collateral Ligament Reconstruction Among Baseball Players: A Systematic Review

Problem: Ulnar collateral ligament $($UCL$)$ reconstruction $($UCLR$)$ is very common in baseball. However, no review has compared the return$-$to$-$play $($RTP$)$ and in$-$game performance statistics of pitchers after primary and revision UCLR as well as of position players after UCLR.

Population: Between $2007$ and $2011,$ patients aged between $15$ and $19$ years accounted for $56\mathrm{.}8\%$ of UCLR procedures, while patients aged between $20$ and $24$ years only accounted for $22\mathrm{.}2\%$ of UCLR procedures. This study is not without limitations$.$ First, most studies that included professional players collected data from the MLB database and therefore included overlapping populations $(2000-2015,1990-2010,$ etc$)$ and likely duplicated participants at times.

Action: In an attempt to limit the injury risk of pitchers after UCLR, the pitching workload was often decreased during the first season after surgery. Even after a structured throwing program is completed throughout rehabilitation, some tissues still may not be prepared to return to normal workloads. Disregarding the need to decrease workloads could result in worse pitching performance$34$ and injuries.

Alternative: Catchers may also require close monitoring after UCLR, with catchers $(59\%-80\%)3,40$ returning to play after primary UCLR less frequently than pitchers $(80\%-97\%),$ infielders $(76\%),3$ and outfielders $(89\%).$ Catchers throw much more often than other position players and play in more games than pitchers, possibly explaining their low RTP rates. Catchers are also sometimes required to throw out base runners, requiring maximal effort and accurate throws.

Results: RTP rates were lower after revision UCLR$5,43$ than after primary UCLR. Keller found that pitchers who underwent revision UCLR pitched in more games and threw more pitches in the season after primary UCLR than pitchers who did not require revision surgery.

Evidence: Pitchers returned to play after UCLR in approximately $12$ months and generally took longer to return to their same level of play likely because of rehabilitation in lower levels of competition. Pitchers also returned to play less frequently after revision UCLR. After both primary and revision UCLR, professional pitchers experienced decreased workloads and potentially decreased fastball usage as well. Catchers may return to play after UCLR less frequently than pitchers, infielders, and outfielders possibly because of the frequency of throwing in the position.