SURGICAL GRAFT SELECTION IN UCL RECONSTRUCTION: A CLINICAL REVIEW OF RETURN-TO-PLAY OUTCOMES IN MLB PITCHERS

Anthony Ferraioli

Co-Presenters: Nicholas Cupo

College: College of Health Professions and Human Services

Major: DPT.PHYSTHERAPY

Faculty Research Mentor: Lee, John  

Abstract:

This research project evaluates the impact of allograft versus autograft ulnar collateral ligament (UCL) reconstruction on return-to-play (RTP) rates in adult professional level baseball pitchers. The UCL is essential for medial elbow stability during overhead throwing, making professional baseball pitchers particularly vulnerable to injury andUCL reconstruction is the standard treatment for these injuries, but graft choice remains debated. Autografts may offer better biological integration but involve donor site risks, while allografts avoid donor site complications but may demonstrate higher failure rates. Recent research shows mixed outcomes regarding RTP and revision rates between graft types. The purpose of this review is to compare RTP outcomes following autograft versus allograft UCL reconstruction in professional baseball pitchers to guide surgical decision-making and performance expectations.A literature review was conducted using research databases, e.g., PubMed, Science Direct, SagePub, and JBSB to identify studies published from 2010–2025 evaluating graft choice and RTP outcomes after UCL reconstruction in professional baseball athletes. Search terms included “UCL reconstruction,” “return to play,” “professional athletes,” “baseball,” “autograft,” and “allograft.” Articles were included if they reported RTP rates in professional baseball athletes who underwent UCL reconstruction. Data extracted included sample size, graft type, and RTP rate. Results were summarized and compared across studies to evaluate the effect of graft choice on surgical outcomes.Across the reviewed studies, both autografts and allografts demonstrated high RTP rates in professional baseball pitchers undergoing UCL reconstruction, with slight variability in consistency and performance outcomes. Autograft reconstruction showed slightly more favorable overall RTP results, while allografts were also associated with strong RTP rates and many athletes returning to the same or higher level of play. Overall, the findings support the effectiveness of both graft types, suggesting graft selection may depend more on individual athlete factors than on major differences in RTP outcomes. Many pitchers successfully returned to play regardless of graft type, and further research is recommended to clarify graft effectiveness and long-term performance outcomes.Keywords: UCL reconstruction, Tommy John surgery, autograft, allograft, return to play