Effect of Predraft Ulnar Collateral Ligament Reconstruction on Future Performance in Professional Baseball: A Matched Cohort Comparison

Self Cite

Background: As the incidence of ulnar collateral ligament (UCL) surgery continues to rise rapidly, an update on the current prevalence and demographics in professional baseball players is warranted. Hypothesis: The prevalence of UCL reconstruction in Major League Baseball (MLB) and Minor League Baseball (MiLB) players will be higher than that previously reported, and the increase in prevalence will be most notable in MiLB pitchers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: During the 2018 baseball season, an online questionnaire regarding a history of UCL surgery was distributed to the certified athletic trainers of all 30 MLB organizations. These trainers then administered the survey to all players within their organizations, including MLB, MiLB (AAA, AA, High A, Low A, High Rookie, Low Rookie), and Dominican Summer League (DSL) players. Demographics were compared between MLB, MiLB, and DSL players. Results of this 2018 survey were compared with previously published data from the 2012 season to assess the change over time. Results: There were 6135 professional baseball players who completed the survey (66% response rate). The prevalence of UCL reconstruction in all MLB and MiLB players was 13% (637/4928), while the prevalence in DSL players was 2% (20/1207) ( P < .001). The prevalence in all MLB and MiLB players (13%) and pitchers (20%) both increased significantly from 2012 ( P < .001). MLB pitchers reported a higher prevalence of UCL reconstruction than did MiLB pitchers (26% vs 19%, respectively; P < .001). In 2018, the prevalence of UCL reconstruction has increased significantly in MiLB pitchers (19% vs 15%, respectively; P < .001) and pitchers aged 21 to 30 years (22% vs 17%, respectively; P < .001) compared with 2012. Additionally, United States–born pitchers were more likely to have undergone UCL reconstruction compared with Latin America–born pitchers (23% vs 13%, respectively; P < .001). Conclusion: The prevalence of UCL reconstruction has increased significantly in professional baseball players over the past 6 years from 10% to 13%. Ultimately, the prevalence of UCL reconstruction has increased most significantly since 2012 in MiLB pitchers, pitchers aged 21 to 30 years, and pitchers born in the United States.

Section: Discussionmentioning

confidence: 99%

Prevalence of Medial Ulnar Collateral Ligament Surgery in 6135 Current Professional Baseball Players: A 2018 Update

Leland

Conte²,

Flynn³

et al. 2019

Self Cite

“…On the basis of our prior experience, we hypothesized that pitchers undergoing UCLR at a younger age, starting pitchers, pitchers with higher BMIs, and pitchers flagged as moderate and high risk by team physicians would be less successful and have a higher risk for reinjury. We also hypothesized, as concluded by Camp et al, 4 that the surgical cohort would be similarly successful to the matched nonsurgical cohort.…”

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confidence: 73%

“…In 2016, in a series of 38 pitchers evaluated after UCLR and compared with a control group, Wymore et al 15 demonstrated statistically similar performance metrics between the cohorts in terms of velocity, wins, ERA, WHIP, games started, innings pitched, wins, losses, strikeouts, and batters walked. In 2018, Camp et al 4 conducted a large matched cohort comparison of 345 pitchers after UCLR and demonstrated a statistically higher likelihood of advancement to the MLB level in the UCLR group. Camp et al 4 also found that the postsurgical cohort had a more rapid progression to successive levels of play (such as A, AA, AAA, or MLB).…”

Section: Discussionmentioning

confidence: 99%

“…Even less is known about the ability of team physicians to perform a risk assessment, or “grade” these players, and how their ratings correlate with their future performance. Two previous reports by Camp et al 4 and Wymore et al 15 comparing drafted players after UCLR with matched controls demonstrated conflicting results, with patients in the postsurgical group performing either similarly or even better than matched cohorts. These reports on drafted pitchers recommended longer follow-up, more pitchers in future studies, an evaluation of the accuracy of subjective team draft grades, and evaluation by pitching role.…”

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confidence: 93%

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Successful Performance After Ulnar Collateral Ligament Reconstruction: An Analysis of 88 Drafted Professional Baseball Pitchers With a Matched Comparison Cohort

Griffith

Duralde

2019

Background:Analysis of pitchers entering the Major League Baseball (MLB) draft after ulnar collateral ligament reconstruction (UCLR) is challenging for team physicians.Purpose:(1) To define the characteristics of pitchers drafted after UCLR associated with placement in AAA and MLB professional levels and completion of a career of at least 3 years, (2) to define characteristics placing pitchers at risk for reinjury after surgery, (3) to compare the professional-level placement and career duration of the UCLR cohort with a matched control group, and (4) to evaluate the accuracy of team physician predraft risk assessments to predict elbow reinjury in pitchers with a history of UCLR.Study Design:Cohort study; Level of evidence, 3.Methods:We analyzed pitchers from a single professional baseball team database who were drafted after UCLR from 2010 to 2013. A matched control group based on position and draft year was selected with the MLB database. The following pitcher characteristics were analyzed: age at the time of UCLR, time from UCLR to the MLB draft, pitching role (starter vs reliever), highest level of play attained, body mass index (BMI), throwing-side dominance, and predraft physician risk assessment. Physician assessments to predict risk for elbow reinjury were derived from operative and clinical history and evaluated for accuracy during the follow-up period. Pitcher characteristics were evaluated for correlation with successful AAA or MLB placement with a career duration of at least 3 years and as risk factors for elbow reinjury. The professional-level achievement and career duration of the UCLR cohort were compared with the matched cohort.Results:A total of 88 pitchers matched the selection criteria and had at least 5 years of follow-up (range, 5-8 years). Pitcher age at the time of UCLR (P = .55), throwing-side dominance (P = .41), and BMI (P = .86) did not correlate with AAA- or MLB-level placement. Relief pitchers (P = .03) and pitchers with a longer time from surgery to final follow-up (P = .02) were more likely to reach the AAA or MLB level. Similarly, pitcher age at the time of UCLR (P = .56), throwing-side dominance (P = .27), and BMI (P = .69) did not correlate with a duration of play of at least 3 years. Relief pitchers (P = .03) and pitchers with a longer time from UCLR to the final follow-up (P = .005) were more likely to achieve at least 3 years of play. There was no difference in AAA or MLB placement between the UCLR and matched cohorts (P = .22). The UCLR cohort achieved a higher duration of play than the matched cohort (P = .002). Pitchers with a BMI >25 kg/m2 had a lower risk of elbow reinjury versus players with a BMI ≤25 kg/m2 (P = .012). Patient age at time of UCLR (P = .92), time from UCLR to the MLB draft (P = .18), pitching role (P = .74), and throwing-side dominance (P = .77) did not correlate with elbow reinjury. Physician risk assessment did not accurately predict reinjury (P = .27). Of the 88 patients, 4 (4.5%) required revision UCLR.Conclusion:Pitcher age at the time of UCLR, throwi...

“…To date, only the impact of UCL reconstruction and shoulder surgery prior to the MLB draft has been investigated, but a macroscopic understanding of the epidemiology and effect on draft rank, availability, and short-term performance remains elusive for all injuries. 3,5,19 The purpose of this study was 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. We hypothesized that shoulder and elbow injuries will make up the majority of musculoskeletal injuries in this population and that those who have had prior orthopaedic surgery are likely to be less available or have decreased performance in the MLB.…”

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confidence: 99%

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

Ramkumar

Navarro

Luu

et al. 2019

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.