scholarly journals Influence of Pitching Release Location on Ulnar Collateral Ligament Reconstruction Risk Among Major League Baseball Pitchers

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982654
Author(s):  
Daniel A. Portney ◽  
Lucas T. Buchler ◽  
Jake M. Lazaroff ◽  
Stephen M. Gryzlo ◽  
Matthew D. Saltzman
Keyword(s):  
Major League Baseball ◽  
Demographic Data ◽  
Ulnar Collateral Ligament ◽  
Lateral Release ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Pitch Tracking ◽  
Major League ◽  
The Mean ◽  
Release Location

Background: Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed among Major League Baseball (MLB) pitchers. The etiology of UCL injury is complex and is not entirely understood. Hypothesis: To better understand risk factors for requiring UCL reconstruction, we hypothesized that pitchers who eventually undergo the procedure will exhibit different throwing mechanics as measured by pitch-tracking data points, such as velocity and release location. Study Design: Case-control study; Level of evidence, 3. Methods: Pitch-tracking and demographic data were gathered for 140 MLB pitchers who had undergone UCL reconstruction between the 2010 and 2017 seasons. Pitch type, release location, and velocity were compared between the surgical cohort and a matched-control cohort. Results: When compared with controls, the mean pitch release location for pitchers who required UCL reconstruction was 12.2 cm more lateral in the year immediately preceding surgery ( P = .001). Furthermore, within the surgical cohort, the horizontal release location was 3.4 cm more lateral immediately preceding surgery compared with 2 years earlier ( P = .036). Binary logistic regression indicated an odds ratio of 0.51, suggesting a roughly 5% increased odds of UCL reconstruction for every 10 cm of increased lateral release location ( P = .048). Both the surgical and the control cohorts threw similar rates of fastballs and had similar mean pitch velocity and fastball velocity. Control pitchers displayed a significant decrease over time in mean pitch velocity ( P = .005) and mean fastball velocity, while pitchers in the UCL reconstruction cohort did not ( P = .012). Conclusion: Pitch tracking indicates that the mean release point is more lateral in pitchers preceding UCL reconstruction as compared with controls, suggesting that a more lateral pitch release location is an independent risk factor for UCL injury and reconstruction.

scholarly journals Effect of Ulnar Collateral Ligament Reconstruction on Pitch Accuracy, Velocity, and Movement in Major League Baseball Pitchers

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096853
Author(s):  
Braden McKnight ◽  
Nathanael D. Heckmann ◽  
Xiao T. Chen ◽  
Kevork Hindoyan ◽  
J. Ryan Hill ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Poor Performance ◽  
Return To Play ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Major League ◽  
The Mean ◽  
Performance Statistics

Background: Ulnar collateral ligament (UCL) reconstruction is frequently performed on Major League Baseball (MLB) pitchers. Previous studies have investigated the effects of UCL reconstruction on fastball and curveball velocity, but no study to date has evaluated its effect on fastball accuracy or curveball movement among MLB pitchers. Purpose/Hypothesis: The primary purpose of this study was to determine the effects of UCL reconstruction on fastball accuracy, fastball velocity, and curveball movement in MLB pitchers. Our hypothesis was that MLB pitchers who underwent UCL reconstruction would return to their presurgery fastball velocity, fastball accuracy, and curveball movement. The secondary purpose of this study was to determine which factors, if any, were predictive of poor performance after UCL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: MLB pitchers who underwent UCL reconstruction surgery between 2011 and 2012 were identified. Performance data including fastball velocity, fastball accuracy, and curveball movement were evaluated 1 year preoperatively and up to 3 years of play postoperatively. A repeated-measures analysis of variance with a Tukey-Kramer post hoc test was used to determine statistically significant changes in performance over time. Characteristic factors and presurgery performance statistics were compared between poor performers (>20% decrease in fastball accuracy) and non—poor performers. Results: We identified 56 pitchers with a total of 230,995 individual pitches for this study. After exclusion for lack of return to play (n = 14) and revision surgery (n = 3), 39 pitchers were included in the final analysis. The mean presurgery fastball pitch-to-target distance was 32.9 cm. There was a statistically significant decrease in fastball accuracy after reconstruction, which was present up to 3 years postoperatively ( P = .007). The mean presurgery fastball velocity of 91.82 mph did not significantly change after surgery ( P = .194). The mean presurgery curveball movement of 34.49 cm vertically and 5.89 cm horizontally also did not change significantly ( P = .937 and .161, respectively). Conclusion: Fastball accuracy among MLB pitchers significantly decreased after UCL reconstruction for up to 3 years postoperatively. There were no statistically significant differences in characteristic factors or presurgery performance statistics between poor and non--poor performers.

scholarly journals Epidemiology and Impact of Prior Musculoskeletal Injury and Orthopaedic Surgery on Draft Rank, Availability, and Short-term Performance in Major League Baseball: A Summary Analysis and Matched Cohort of 1890 Predraft Players

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984426
Author(s):  
Prem N. Ramkumar ◽  
Sergio M. Navarro ◽  
Bryan C. Luu ◽  
Heather S. Haeberle ◽  
Jaret M. Karnuta ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Musculoskeletal Injury ◽  
Musculoskeletal Injuries ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Short Term ◽  
Level Of Evidence ◽  
Major League

Background: Despite the many reports of injury rates in Major League Baseball (MLB), little is known about the epidemiology or impact of prior musculoskeletal injuries and surgical procedures among players entering the MLB draft. Purpose: To determine the (1) epidemiology of all musculoskeletal injuries and surgical procedures among players entering the MLB draft, (2) impact of injury or surgery on draft rank, (3) impact of injury or surgery on availability within the first 2 years of play in the MLB, and (4) impact of injury or surgery on performance. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed 1890 medical records that were completed by MLB team physicians as preparticipation physical assessment prior to the draft from 2014 to 2018. Players were divided into 3 groups: noninjured, nonoperative, and operative. Draft status, overall draft rank, missed games, batting average, and earned run average for the first 2 seasons of MLB play were obtained for all available players. Players across all 3 groups were compared with linear, logistic, and beta regression models, controlling for age, position, injury status, and draft rank. Unadjusted differences among groups were assessed with 1-way analysis of variance. Results: Overall, 750 position players and 1140 pitchers were included, of whom 22.8% had no reported injury history; 48.8% reported injury treated nonoperatively; and 28.5% were treated operatively. The most common predraft injuries were elbow tendinitis (n = 312), ulnar collateral ligament injury (n = 212), and shoulder labral tear (n = 76). The most common predraft treatments were physical therapy (n = 922), ulnar collateral ligament reconstruction (n = 115), and fracture fixation (n = 69). Of the 1890 players, 719 were drafted and played for at least 2 years. No difference was found among noninjured, nonoperative, and operative groups in terms of draft rank, games missed, or performance. Players with a nonoperative injury had a decreased odds ratio of being drafted (0.738; P = .017). Conclusion: More than half of the players entering the MLB reported a history of musculoskeletal injury requiring treatment, and the most commonly affected joints were the shoulder and elbow. Musculoskeletal history did not affect draft rank, short-term availability, or performance for MLB prospects.

scholarly journals Reasons for Retirement Following Ulnar Collateral Ligament Reconstruction Among Major League Baseball Pitchers

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774502 ◽  
Author(s):  
Brandon J. Erickson ◽  
Junyoung Ahn ◽  
Peter N. Chalmers ◽  
Christopher S. Ahmad ◽  
Bernard R. Bach ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Control Group ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Elbow Injury ◽  
Major League ◽  
History Of ◽  
Ulnar Collateral Ligament Reconstruction

Background: Ulnar collateral ligament reconstruction (UCLR) has become an increasingly common procedure among Major League Baseball (MLB) pitchers. The long-term effects of this procedure on the career of an MLB pitcher are largely unknown. Purpose/Hypothesis: The purpose of this study was to determine why and when MLB pitchers who underwent UCLR during their careers retired from baseball as compared with controls. We hypothesized that pitchers who underwent UCLR are no more likely than control pitchers to retire from elbow or shoulder problems. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All MLB pitchers who underwent UCLR were identified through publicly available data. A cohort of pitchers who did not undergo UCLR were matched to pitchers with a history of UCLR, based on sex, age, draft year, and draft round. Of those who were no longer pitching in the MLB, the reason for retirement was determined. Reason for retirement and length of career following UCLR (surgical group) and index year (control group) were determined and compared through prior studies via the MLB HITS database, MLB team websites, and publicly available internet-based injury reports. Results: Overall, 153 MLB pitchers who underwent UCLR between 1974 and 2015 are currently retired. Mean ± SD time to retirement was 4.4 ± 4.7 years (range, 0-26 years) after the index year in the control group and 4.4 ± 3.5 years (range, 0-15 years) after surgery in the UCLR group ( P = .388). Patients who were status post-UCLR were significantly more likely to be released during the season (34 of 144, 23.6%) than were players who were not status post-UCLR (14 of 144, 9.7%) ( P = .002). Shoulder injury as a reason for retirement was more common in the control group than the UCLR group ( P = .011). Elbow injury as a reason for retirement was not more common in either group ( P = .379). Leg injury as a reason for retirement was more common in the control group ( P = .013). Performance as a reason for retirement was more common in the UCLR group than the control group ( P < .001). Conclusion: MLB pitchers who have undergone UCLR are no more likely to retire from shoulder or elbow injuries than are those who have not undergone UCLR. MLB career length was similar between pitchers with and without a history of UCLR.

scholarly journals Release Location in a Risk Factor for Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0016
Author(s):  
Daniel Aaron Portney ◽  
Lucas T. Buchler ◽  
Jake Michael Lazaroff ◽  
Stephen Gryzlo ◽  
Matthew Saltzman
Keyword(s):  
Risk Factor ◽  
Reconstructive Surgery ◽  
Ligament Reconstruction ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Control Cohort ◽  
Collateral Ligament ◽  
Pitch Tracking ◽  
Release Location ◽  
Ulnar Collateral Ligament Reconstruction

Objectives: Medial ulnar collateral ligament reconstruction (UCLR) is a common procedure performed for Major League Baseball (MLB) pitchers. The etiology of UCL injury is complex and not entirely understood. The purpose of this study was to use publically available pitch tracking technology (PITCHf/x) to compare the pre-injury throwing mechanics of MLB pitchers who require UCL reconstructive surgery with those of pitchers who have never undergone UCL reconstruction. Methods: Pitch tracking and demographic data on MLB pitchers who had undergone UCL reconstruction between the 2010 and 2017 seasons was gathered. Pitchers were excluded if they did not throw 100 total pitches in each of the three years prior to surgery. Furthermore, only pitch types that a given pitcher utilized more than 25 times in each of the three years prior to surgery were included for individual analysis. Pitch type, release location, and velocity were compared between the UCL reconstructive surgery cohort and a matched-control cohort. Results: The average pitch release location for pitchers who required UCL reconstruction was more lateral in the two years immediately preceding surgery than the control cohort (p=0.001 and p=0.023). Furthermore, a time-based comparison between the year immediately preceding surgery and two years prior showed a more lateral release immediately prior to surgery (p=0.036). Pitchers who required UCL reconstruction throw similar rates of fastballs as the control cohort and the average pitch velocity and fastball velocity were similar between the UCL group and the control group. The control pitchers displayed a significant decrease in average pitch velocity (p=0.005) and average fastball velocity (p=0.012) over the period of the study. Conclusion: Pitch tracking indicates pitch selection and pitch velocity are similar before that the average release point is more lateral preceding UCL reconstruction as compared to the control cohort suggesting that pitch release location might be an independent risk factor for UCL injury and reconstruction. On the other hand, pitch selection and pitch velocity are similar between these cohorts. Powerful technology including PITCHf/x allows for accurate monitoring of factors such as arm position and could potentially be used to identify pitchers at risk for UCL rupture. [Figure: see text]

scholarly journals Effect of COVID-19 on Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110413
Author(s):  
Ryan W. Paul ◽  
Ali Omari ◽  
Brian Fliegel ◽  
Meghan E. Bishop ◽  
Brandon J. Erickson ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Injury Rates ◽  
Major League ◽  
Before And After ◽  
Surgery Timing ◽  
Pooled Sample

Background: The coronavirus disease of 2019 (COVID-19) pandemic led to the suspension and shortening of the 2020 Major League Baseball (MLB) season from 162 to 60 regular season games. The effect of this disruption on injury rates, specifically injury to the ulnar collateral ligament (UCL), has not been quantified. Purpose/Hypothesis: The purpose of this study was to compare the rate of UCL reconstruction (UCLR), surgery timing, and pitching workload in MLB pitchers from before and after the COVID-19 pandemic lockdown. We hypothesized that UCLR rates relative to games played would be increased and pitching workload would be decreased in 2020 compared with previous seasons. Study Design: Cohort study; Level of evidence, 3. Methods: An extensive online search using publicly available data was conducted to identify all MLB pitchers who underwent UCLR between January 1, 2017, and December 31, 2020. Only pitchers who were competing at the MLB level when undergoing reconstruction were included. Player characteristics and surgery date, as well as career and season of surgery pitching workload, were collected for all included pitchers. All data were compared as a pooled sample (2017-2019 vs 2020). Results: A similar number of pitchers underwent UCLR during or after the 2020 regular season (n = 18) compared with the 2017-2019 seasons (n = 16, 20, and 16, respectively). However, after accounting for the decrease in games played during the 2020 regular season, an MLB pitcher was 2.9 times more likely to undergo surgery per game after the COVID-19 lockdown compared with the previous years ( P < .001). MLB pitchers who underwent surgery in 2020 threw fewer preseason innings than did pitchers who underwent surgery between 2017 and 2019 (5.98 vs 9.39; P = .001). Conclusion: MLB pitchers were almost 3 times more likely to undergo UCLR per game after the COVID-19 lockdown. A decreased preseason pitching workload because of the COVID-19 lockdown may have had an effect on per game UCLR rates.

scholarly journals Should We Limit Innings Pitched Following Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers?

2016 ◽  
Vol 4 (7_suppl4) ◽  
pp. 2325967116S0010
Author(s):  
Brandon J. Erickson ◽  
Gregory Cvetanovich ◽  
Bernard R. Bach ◽  
Charles A. Bush-Joseph ◽  
Nikhil N. Verma ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Major League ◽  
Baseball Pitchers ◽  
Ulnar Collateral Ligament Reconstruction

scholarly journals Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095914
Author(s):  
Justin C. Kennon ◽  
Erick M. Marigi ◽  
Chad E. Songy ◽  
Chris Bernard ◽  
Shawn W. O’Driscoll ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Ulnar Neuropathy ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Functional Scores ◽  
The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

Major League Baseball Pitching Performance After Tommy John Surgery and the Effect of Tear Characteristics, Technique, and Graft Type

2019 ◽  
Vol 47 (3) ◽  
pp. 713-720 ◽  
Author(s):  
Nathan E. Marshall ◽  
Robert Keller ◽  
Orr Limpisvasti ◽  
Brian Schulz ◽  
Neal ElAttrache
Keyword(s):  
Surgical Technique ◽  
Major League Baseball ◽  
Surgical Techniques ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Level Of Evidence ◽  
Partial Tears ◽  
Major League ◽  
Before And After ◽  
Performance Statistics

Background: Return to play and player satisfaction have been quite high after ulnar collateral ligament reconstruction (UCLR); however, there has been little reported on how outcomes are affected by surgical technique, graft type, and tear characteristics. Purpose: To evaluate surgical techniques, graft type, and tear characteristics on Major League Baseball (MLB) performance after UCLR. Study Design: Cohort study; Level of evidence, 2. Methods: MLB pitchers who underwent primary UCLR at a single institution were included. Tear characteristics included tear location, tear grade, and acuity. Surgical technique and graft type were also collected. Pitching performance statistics, including earned run average (ERA), walks and hits per innings pitched (WHIP), innings pitched, and fastball velocity were evaluated 3 years before and after UCLR. Results: Forty-six MLB pitchers were identified as having primary UCLR. Return to play was 96%, with 82% returning to MLB play. Technique performed showed no difference in performance. As compared with pitchers with gracilis grafts, pitchers with palmaris grafts were younger ( P = .043), played longer after surgery ( P = .012), and returned to play at 100% (35 of 35) versus 82% (9 of 11, P = .010). When compared with pitchers with proximal tears, pitchers with distal tears pitched at higher velocity (93.0 vs 90.6 mph, P = .023) and had better performance before surgery (ERA, P = .003; WHIP, P = .021); however, those with proximal tears improved to match this performance and velocity after reconstruction. As compared with those having partial tears, pitchers with complete tears played longer after surgery (5.9 vs 4.0 years, P = .033), had a better ERA before injury ( P = .041), and had better WHIP ( P = .037) and strikeouts per 9 innings ( P = .025) after reconstruction. Pitchers with chronic tears had a significant improvement in postoperative ERA, from 4.49 to 3.80 ( P = .040). Conclusion: Technique performed and graft type used did not affect performance; however, pitchers with palmaris grafts returned at a higher rate than those with gracilis grafts. Distal tears occurred in pitchers with greater velocity and better performance before injury, yet pitchers with proximal tears matched this performance after reconstruction. Pitchers with complete tears played longer after reconstruction. Pitchers who had partial tears had worse performance before injury and after reconstruction, and those with chronic tears saw a significant improvement in ERA with reconstruction.

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