Predictors of Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

Background:Repetitive pitching produces significant stress on the elbow that may result in structural abnormalities discernable on magnetic resonance imaging (MRI) without causing symptoms.Purpose:To determine whether there exists an association between subclinical MRI findings in asymptomatic elbows of Major League Baseball (MLB) players and future placement on the disabled list (DL) or future operative procedure.Study Design:Cohort study; Level of evidence, 3.Methods:MRI scans of the elbows of professional-level baseball pitchers, taken during routine presigning imaging at a single organization from 2005 to 2017, were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with an injury before the earliest session of elbow MRI. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of chondral damage to the joint, loose bodies, ulnar collateral ligament (UCL) heterogeneity or tears, flexor pronator mass defects, and signs of posteromedial (PM) impingement. Binary imaging findings were related to future placement on the DL for elbow complaints and future elbow surgery.Results:A total of 41 pitchers had asymptomatic MRI findings with no prior DL placement. For players who eventually went on the DL, there were a statistically greater number of players with UCL heterogeneity (P = .021), humeral-sided partial UCL tears (P = .031), and PM impingement (P = .004) on preinjury MRI compared with players who remained healthy. PM impingement was related to future elbow-related surgery (P = .003). Pitchers with UCL heterogeneity were associated with reduced career strike zone percentage, innings pitched, and fastball percentage (P < .05 for all).Conclusion:UCL heterogeneity, PM impingement, and humeral-sided partial tears were correlated with future DL placement for elbow-related reasons in MLB pitchers. Asymptomatic PM impingement may be a precursor to future surgery.

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging Findings of the Asymptomatic Elbow Predict Injuries and Surgery in Major League Baseball Pitchers

Garcia

Gowd

Cabarcas

et al. 2019

“…The implication of workload and its influence on injury risk has been extensively discussed in the literature. 11,12,22,26 The relationship between parameters of workload and ROM over a baseball season has been studied in the hip in collegiate baseball players but, to our knowledge, has not been examined in the shoulder or elbow. This study did not demonstrate a correlation between innings pitched, total number of pitches thrown, or mean fastball velocity and ROM changes over a season.…”

Section: Discussionmentioning

confidence: 99%

Shoulder and Elbow Range of Motion Can Be Maintained in Major League Baseball Pitchers Over the Course of the Season, Regardless of Pitching Workload

McGraw

Vrla

Wang

et al. 2019

Background:Studies examining the evolution of shoulder and elbow range of motion (ROM) in baseball pitchers over a single season have yielded inconsistent results.Purpose:To evaluate shoulder and elbow ROM in Major League Baseball (MLB) pitchers over a single season and to assess for correlations between these changes and measures of a pitcher’s workload.Study Design:Case-control study; Level of evidence, 3.Methods:Bilateral shoulder ROM (internal rotation [IR], external rotation [ER], and total range of motion [TROM]) was assessed in 92 MLB pitchers pre- and postseason. Shoulder forward flexion (FF) was measured in 64 pitchers, horizontal adduction (HA) was measured in 87 pitchers, and elbow ROM was measured in 86 pitchers. Data collected included demographics (age, height, weight, and body mass index) and measures of workload for pitchers (pitches thrown, innings pitched, and mean fastball velocity). Pitchers were not specifically excluded if they had an injury during the season but had recovered and were actively pitching at the time of postseason measurements. The change in motion from pre- to postseason was measured and the associations with player demographics and workload were calculated by use of the Pearson correlation coefficient.Results:On average, pitchers demonstrated an increase in dominant shoulder ER from 118.8° to 125.4° (P < .001) and TROM from 173.1° to 181.7° (P < .001). HA was increased by an average of 15.7° (P < .001). The average shoulder IR (P = .189), FF (P = .432), and elbow ROM (flexion, P = .549; extension, P = .185) remained similar over the span of the season. Average glenohumeral IR deficit did not increase. Pitcher demographics and measures of throwing workload (total pitches thrown, innings pitched, mean fastball velocity) were not significantly correlated with changes in shoulder or elbow ROM.Conclusion:Significant increases in dominant shoulder ER, TROM, and HA were identified in MLB pitchers over the course of a single baseball season. These ROM changes were not correlated with measures of pitching workload.

“…Knowledge of which players are likely to incur an injury has the potential of offering not only early interventions but also informed decision making for the organization before signing players to multiyear, multimillion-dollar contracts. 28 Certainly, the ethics of predicting injuries merits a discussion. The implication of assigning a player such a value runs the risk of diminishing the player's value to a franchise.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Outperforms Regression Analysis to Predict Next-Season Major League Baseball Player Injuries: Epidemiology and Validation of 13,982 Player-Years From Performance and Injury Profile Trends, 2000-2017

Karnuta

Luu

Haeberle

et al. 2020

Background: Machine learning (ML) allows for the development of a predictive algorithm capable of imbibing historical data on a Major League Baseball (MLB) player to accurately project the player's future availability. Purpose: To determine the validity of an ML model in predicting the next-season injury risk and anatomic injury location for both position players and pitchers in the MLB. Study Design: Descriptive epidemiology study. Methods: Using 4 online baseball databases, we compiled MLB player data, including age, performance metrics, and injury history. A total of 84 ML algorithms were developed. The output of each algorithm reported whether the player would sustain an injury the following season as well as the injury’s anatomic site. The area under the receiver operating characteristic curve (AUC) primarily determined validation. Results: Player data were generated from 1931 position players and 1245 pitchers, with a mean follow-up of 4.40 years (13,982 player-years) between the years of 2000 and 2017. Injured players spent a total of 108,656 days on the disabled list, with a mean of 34.21 total days per player. The mean AUC for predicting next-season injuries was 0.76 among position players and 0.65 among pitchers using the top 3 ensemble classification. Back injuries had the highest AUC among both position players and pitchers, at 0.73. Advanced ML models outperformed logistic regression in 13 of 14 cases. Conclusion: Advanced ML models generally outperformed logistic regression and demonstrated fair capability in predicting publicly reportable next-season injuries, including the anatomic region for position players, although not for pitchers.