Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in professional baseball position players. Timing of return to hitting after UCLR is unknown. Purpose/Hypothesis: The purpose was to determine the time to return to batting milestones after UCLR as well as the effect of UCLR upon batting performance in professional baseball players. The hypothesis was that position players would return to batting in an in-season game before fielding in an in-season game, and hitting performance would remain unchanged after UCLR. Study Design: Cohort study; Level of evidence, 3. Methods: All professional position players who underwent UCLR between 2010 and 2018 were included. Time to batting milestones after UCLR was analyzed. Batting performance before and after UCLR was compared and analyzed. Results: Overall, 141 UCLRs (96% performed on the dominant arm) in 137 position players were included (86% Minor League players). Four players underwent revision, all within 1 year of the primary UCLR. With regard to position, catchers and shortstops were overrepresented. With regard to batting side, 57% batted from the right and 12% batted as switch-hitters. Of the surgeries, 76% were on the trail/back arm. While 91% of players returned to some form of throwing, there was a progressive gradual decline as the rehabilitation process progressed, as only 77% were able to return to hitting in a real game and 75% were able to return to fielding in a real game. The first dry swing occurred at 150 ± 49 days after surgery, the first batting practice occurred at 195 ± 58 days after surgery, the first hitting in a real game occurred at 323 ± 92 days after surgery, and the first fielding in a real game occurred at 343 ± 98 days after surgery. However, players generally saw a decrease in their utilization, with fewer at bats (P < .001) translating into fewer hits (P < .001) and runs (P < .001). Conclusion: Professional position players begin swinging at 150 days (approximately 5 months) after UCLR, while they do not hit in batting practice until 195 days (approximately 6.5 months) and do not hit in a real game until 323 days (approximately 10.7 months) after UCLR. Players see a decrease in hitting utilization after UCLR. On average, players hit in a real game 20 days before fielding in a real game.
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