EBP Research Review

Heavy Workload May be a Risk Factor for Revision Tommy John Procedure

A report from the Kerlan-Jobe clinic, published in the Journal of Shoulder and Elbow surgery, has found that pitchers with a large increase in innings pitched follow Tommy John surgery are most at risk to have another injury that may require a second Tommy John revision procedure.  As Tommy John injuries continue to side in Major League Baseball, we are starting to now also see a rise in failures that require a second procedure.

Pitchers that required a second surgery pitched in more games, threw more innings, and threw more pitches than a group of pitchers that did not require a second Tommy John revision.   Conversely, pitchers that did not go on to needing a second procedure pitched less games, threw less innings, and threw less pitches.

The results of this study show workload and overuse may be contributing factors to failing Tommy John surgery.  Furthermore, it may be advantageous to intentionally reduce workload in the year following Tommy John surgery to reduce the risk of failure.


Relative individual workload changes may be a risk factor for rerupture of ulnar collateral ligament reconstruction

Keller RA1, Mehran N2, Khalil LS3, Ahmad CS4, ElAttrache N2.  J Shoulder Elbow Surg. 2017 Mar;26(3):369-375. doi: 10.1016/j.jse.2016.11.045.

Author information

  • 1Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA. Electronic address: [email protected].
  • 2Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA.
  • 3Wayne State University School of Medicine, Detroit, MI, USA.
  • 4Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University, New York, NY, USA.



With an increasing number of Major League Baseball (MLB) players undergoing ulnar collateral ligament (UCL) reconstruction, there remains limited literature on appropriate post-reconstruction workload management to limit the risk of reinjury.


A total of 28 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction were identified and compared with 137 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared 3 years before and after primary reconstruction. Results were then compared between groups.


Pitchers who later required revision increased their games pitched by 14.1% after reconstruction whereas the no-revision group pitched 13.6% fewer games than before reconstruction (P < .01). Inning workload was reduced by 9.8% after surgery (89.8 innings after vs 99.6 innings before) for the revision group compared with the no-revision group, which threw 26% fewer innings after surgery (86.3 innings after vs 116.7 innings before) (P = .05). In addition, the revision group pitched 6.6% more pitches after reconstruction, 1138.9 pitches, compared with before reconstruction, 1068.6 pitches. Pitchers who did not require revision, in contrast, pitched 19.6% fewer pitches after reconstruction than before reconstruction (P = .08).


This study’s findings suggest that MLB pitchers who require revision UCL reconstruction after returning to play following primary UCL reconstruction pitch at or above their pre-primary UCL reconstruction workload whereas control pitchers who do not require revision pitch significantly less, below their pre-primary UCL reconstruction workload.

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Mike Reinold

Website at MikeReinold.com
Mike Reinold, DPT, SCS, CSCS, is a world renowned physical therapist and performance enhancement specialist and the former Head Athletic Trainer and Physical Therapist of the Boston Red Sox. He is currently the owner of MikeReinold.com and Champion PT and Performance just outside Boston, MA.
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3 replies
  1. Jarad Vollkommer
    Jarad Vollkommer says:

    I find this study interesting. It further shows how important relative, acute/chronic workload is for a pitcher not only for performance enhancement, but for injury prevention as well.

    • Mike's Reinold
      Mike's Reinold says:

      That’s right. The Motus sleeve is actually helping with this acute:chronic ration now too. Going to be interesting…

    • Mike Reinold
      Mike Reinold says:

      That’s right. The Motus sleeve is actually helping with this acute:chronic ration now too. Going to be interesting…


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