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

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.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120968530 ◽

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.

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Risk Stratification for Ulnar Collateral Ligament Injury in Major League Baseball Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967115627126 ◽

2016 ◽

Vol 4 (2) ◽

pp. 232596711562712 ◽

Cited By ~ 17

Author(s):

Steven F. DeFroda ◽

Peter K. Kriz ◽

Amber M. Hall ◽

David Zurakowski ◽

Paul D. Fadale

Keyword(s):

Risk Stratification ◽

Major League Baseball ◽

Ulnar Collateral Ligament ◽

Ligament Injury ◽

Collateral Ligament ◽

Baseball Players ◽

Major League ◽

Ulnar Collateral Ligament Injury

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Performance Analytics and Pitch Metrics as Predictors of Ulnar Collateral Ligament Injury in Major League Baseball Pitchers (128)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00271 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0027

Author(s):

Matthew Fury ◽

Donna Scarborough ◽

Luke Oh ◽

Joshua Wright-Chisem ◽

Jacob Fury ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Injury Risk ◽

Major League Baseball ◽

Ulnar Collateral Ligament ◽

Ligament Injury ◽

Control Group ◽

Collateral Ligament ◽

Significant Difference ◽

Major League

Objectives: Ulnar collateral ligament (UCL) injury is a significant concern in elite throwers, and it is associated with prolonged time away from competition in Major League Baseball (MLB) pitchers. Identifying athletes at higher risk of injury, with the subsequent goal of injury prevention, may positively impact pitcher health while mitigating the significant economic impact of this injury on professional organizations. As technology continues to advance, more granular assessments of performance are becoming possible. In 2015, Major League Baseball introduced StatCast, a spatiotemporal data tracking system that uses a standardized camera system and radar technology, to optically track player and ball movement to measure and quantify game events. This technology allows for further investigation of the science of pitching and provides new frontiers for injury research. Understanding UCL injuries in MLB pitchers may also provide insight into youth pitching injuries. To date, there is a paucity of evidence regarding risk factors of UCL injury in MLB pitchers. Methods: All MLB pitchers who underwent primary UCLR between 2015 and 2019 were identified from publicly available reports. This date range was selected to capture the seasons in which Statcast data was available. Advanced analytics and pitch metrics from the injury season—including velocity, spin rates, and pitch movement from MLB StatCast data—were collected as well as the seasonal data of an uninjured control group. Binomial logistic regression analysis was performed to determine risk factors for UCL injury. Results: Seventy-six MLB pitchers undergoing primary UCL reconstruction were included, and a control group of 95 uninjured pitchers was identified. There was no significant difference in age, height, weight, or BMI between the two cohorts. A logistic regression model was created using the following variables: 4-seam fastball velocity, 4-seam fastball spin rate, slider spin rate, curveball spin rate, strikeout percentage, and wins above replacement (WAR). The model explained 18.4% of the variance and predicted 70.4% of UCL injuries. Increasing WAR was associated with increasing likelihood of subsequent UCL injury (odds ratio [OR] 2.34; 95% CI, 1.08–5.07; p = 0.031). Conclusions: When controlling for fastball velocity and pitch spin rates, MLB pitchers who are more valuable, as indicated by WAR, may be at an elevated risk of UCL injury. While velocity is a known risk factor for UCL injury, this model indicates that other factors, including performance or pitch metrics, may influence single-season injury risk and warrant future investigation in multi-year studies.

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Major League Baseball pitch velocity and pitch type associated with risk of ulnar collateral ligament injury

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2015.12.027 ◽

2016 ◽

Vol 25 (4) ◽

pp. 671-675 ◽

Cited By ~ 31

Author(s):

Robert A. Keller ◽

Nathan E. Marshall ◽

John-Michael Guest ◽

Kelechi R. Okoroha ◽

Edward K. Jung ◽

...

Keyword(s):

Major League Baseball ◽

Ulnar Collateral Ligament ◽

Ligament Injury ◽

Collateral Ligament ◽

Major League ◽

Ulnar Collateral Ligament Injury

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117745021 ◽

2017 ◽

Vol 5 (12) ◽

pp. 232596711774502 ◽

Cited By ~ 3

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.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211041359 ◽

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.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119826540 ◽

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.

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Effect of Younger Starting Pitching Age on Humeral Retrotorsion in Baseball Pitchers With an Ulnar Collateral Ligament Injury

The American Journal of Sports Medicine ◽

10.1177/0363546521990808 ◽

2021 ◽

pp. 036354652199080

Author(s):

Sean M. Kennedy ◽

Joseph P. Hannon ◽

John E. Conway ◽

Kalyssa Creed ◽

J. Craig Garrison

Keyword(s):

Ulnar Collateral Ligament ◽

Ligament Injury ◽

Collateral Ligament ◽

Level Of Evidence ◽

Baseball Players ◽

Significant Difference ◽

Ulnar Collateral Ligament Injury ◽

Baseball Pitchers ◽

Group 2 ◽

Group 1

Background: Increased humeral retrotorsion (HRT) has been found to be a risk factor for ulnar collateral ligament (UCL) tears in baseball players. Recent work has demonstrated the age of 11 years as a potential watershed age for HRT development. Hypothesis: In a group of baseball pitchers with UCL injuries, athletes who started pitching before the age of 10 years will demonstrate significantly more dominant limb humeral retrotorsion (DHRT) when compared with a group of baseball pitchers who reported starting pitching at 10 years or older. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 baseball pitchers with a diagnosed UCL injury were divided into 2 groups based upon the age at which participants began pitching: 33 players reporting a starting pitching age of 10 years or older (group 1) were compared with 51 baseball pitchers reporting a starting pitching age under 10 years (group 2). Participants’ DHRT and nondominant limb humeral retrotorsion (NDHRT) were measured using diagnostic ultrasound. Independent t tests were run to compare mean group differences of all patient data, starting pitching age, age at time of injury, DHRT, NDHRT, and humeral retrotorsion difference (HRTdiff). Results: There were no significant differences between groups with regard to age at time of injury, height, weight, or playing years’ experience. There was a statistically significant difference in the participant-reported starting pitching age. Significant differences between groups were noted for DHRT (group 1: 20.0°± 9.4°, group 2: 14.5°± 10.3°, P = .015) and for NDHRT (group 1: 38.6°± 8.8°, group 2: 32.9°± 9.5°, P = .007). No significant differences between groups were found for HRTdiff ( P = .940). Conclusion: Baseball pitchers with a UCL injury who reported a starting pitching age younger than 10 years demonstrated significantly greater DHRT and NDHRT when compared with UCL-injured baseball pitchers who reported a starting pitching age at 10 years or later. The results of this study demonstrate that a younger starting pitching age results in increased HRT in players with UCL injuries.

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