Return to Sport Following Shoulder Surgery in the Elite Pitcher: A Systematic Review

Joshua D. Harris, Jonathan M. Frank, Mark A. Jordan, Charles A. Bush-Joseph, Anthony A. Romeo, Anil K. Gupta, Geoffrey D. Abrams, Frank M. McCormick, Bernard R. Bach

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations


Context: The ability to return to elite pitching, performance, and clinical outcomes of shoulder surgery in elite baseballpitchers are not definitively established.Objective: To determine (1) the rate of return to sport (RTS) in elite pitchers following shoulder surgery, (2) postoperativeclinical outcomes upon RTS, and (3) performance upon RTS and to compare RTS rates in different types of shoulder surgery.Data Sources: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines andchecklist, Medline, SciVerse Scopus, SportDiscus, and Cochrane Central Register of Controlled Trials were searched.Study Selection: Levels I-IV evidence were eligible for inclusion if performance-based (eg, RTS) and/or clinical outcome-based reporting of outcomes were reported following surgical treatment of shoulder pathology in elite pitchers (major orminor league or collegiate).Data Extraction: Subject, shoulder, and pre- and postoperative performance-based variables of interest were extracted.All shoulder surgery types were potentially inclusive (eg, open, arthroscopic, rotator cuff, labrum, biceps, acromioclavicularjoint, fracture). Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS).Results: Six studies were analyzed (287 elite male pitchers [mean age, 27 years] who underwent shoulder surgery, with99% on the dominant, throwing shoulder). MCMS was 38 (poor). Most pitchers were professional, with a mean career lengthof 6.58 years and postoperative clinical follow-up of 3.62 years. In 5 of 6 studies, multiple diagnoses were addressed concomitantlyat surgery. Rate of RTS was 68% at mean 12 months following surgery. Twenty-two percent of Major LeagueBaseball (MLB) pitchers never RTS in MLB. Overall performance did improve following surgery; however, this did notimprove to pre-injury levels.Conclusion: In this systematic review, the rate of return to elite baseball pitching following surgery was established.Performance tended to decrease prior to surgery and gradually improve postoperatively, though not reaching pre-injury levelsof pitching.Level of Evidence: IV (systematic review of studies level I-IV evidence), therapeutic.

Original languageEnglish (US)
Pages (from-to)367-376
Number of pages10
JournalSports Health
Issue number4
StatePublished - Jul 2013


  • arthroscopy
  • Major League Baseball
  • pitcher
  • shoulder
  • surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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