Rate of Return to Prior Performance between Pitchers and Nonpitchers in Adolescent Baseball Players after Surgical Management for Capitellar Osteochondritis Dissecans: A Systematic Review and Meta-analysis

Background: Capitellar osteochondritis dissecans (OCD) tremendously affects young baseball players’ careers, but there is a lack of systematic reviews investigating differences in return to prior performance (RTPP) between pitchers and nonpitchers. Objectives: This study aims to systematically evaluate the RTPP of nonpitchers and pitchers following the surgeries of capitellar OCD. Materials and Methods: The study design involves meta-analysis. This systematic search of PubMed, EMBASE, and Cochrane Library was conducted from database inception until June 30, 2024, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria for eligible articles included English language, randomized controlled trial, retrospective cohort, and case series, reporting return-to-play level following capitellar OCD surgery, and illustrating different fielding positions. Exclusion criteria included abstracts, reviews, textbook chapters, opinion articles, editorials, and conference papers. The quality of the individual study was assessed using the Methodological Index for Nonrandomized Studies scale or the JBI Critical Appraisal Checklist for Case Series. Results: Nine studies consisting of 136 adolescent capitellar OCD baseball players (52 pitchers, 84 nonpitchers) treated with surgery were included. Patient ages ranged from 10 to 17 years old at the surgery. The pooled RTPP rate between pitchers and nonpitchers in baseball players is 65.4% and 83.3%, with significant differences (odds ratio = 0.30, 95% confidence interval, 0.12, 0.76; P = 0.01, I 2 = 0%). Conclusion: This study revealed that young nonpitchers have a greater chance of returning to a higher level of play than pitchers after capitellar OCD surgery during adolescence. The young baseball players who underwent reconstructive surgery may require more time to return to their preoperative performance level and generally have a higher likelihood of requiring revision surgery.