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Do Outcomes or Subsequent Injuries Differ After Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Autograft?

Background: Ulnar collateral ligament reconstruction (UCLR) is a successful procedure in professional baseball players. It is unclear whether graft choice affects results. Purpose: Determine performance and rate of return to sport (RTS) in professional baseball players after UCLR and compare performance and RTS rate, as well as injury rates, between players who underwent UCLR with hamstring versus palmaris autograft. Hypothesis: A high RTS rate exists in professional baseball players after UCLR, with no significant difference in injury rates, RTS rates, or performance specifically related to primary outcome performance variables—WHIP ([walks + hits]/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)—between those who undergo UCLR with palmaris versus hamstring autograft. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent UCLR with hamstring autograft between 2010 and 2015 were included. Surgical details were gathered from operative reports. Players with hamstring UCLR were compared with a matched control group of players who underwent UCLR with palmaris autograft. Results: Overall, 195 players underwent UCLR with hamstring autograft. No differences in RTS rates or timing to RTS were found between the hamstring and palmaris groups. Significantly more subsequent injuries to the contralateral lower extremity were seen in the hamstring group versus the palmaris group (25 vs 13, respectively) (P = .040). More subsequent injuries to the upper extremity were found in the palmaris group versus the hamstring group (73 vs 55, respectively), although this difference was not significant (P = .052). No consistent differences in performance metrics upon RTS existed between hamstring and palmaris groups, although both groups significantly declined in many performance metrics after surgery. Both hamstring and palmaris groups showed a decline postoperatively in WAR (0.86 vs 0.35 and 1.23 vs 0.34, respectively) and WHIP (1.33 vs 1.44 and 1.36 vs 1.51, respectively); FIP did not decline (4.56 vs 5.27 and 4.51 vs 4.53, respectively). No significant difference in WAR, WHIP, or FIP existed between groups postoperatively. Conclusion: Baseball players who underwent UCLR with hamstring autograft were more likely to sustain a subsequent lower extremity injury, whereas those who underwent UCLR with palmaris autograft had a trend toward sustaining more upper extremity injuries. No difference in performance or RTS rates existed between groups. Both groups significantly declined in WAR and WHIP after UCLR.