Retrospective Analysis of Ulnar Collateral Ligament Reconstructions in Major League Baseball Pitchers: A Comparison of the “Tall and Fall” Versus “Drop and Drive” Pitching Styles

Abstract

Background: Previous pilot research has investigated differences in elbow valgus torque between the “tall and fall” (TF) and “drop and drive” (DD) pitching styles. Whether one of these pitching styles is associated with a greater rate of ulnar collateral ligament reconstruction (UCLR) is currently unknown. Purpose: To determine the proportion of Major League Baseball (MLB) pitchers using the TF and DD pitching styles who underwent UCLR over a 10-year period. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The demographic characteristics of pitchers who underwent UCLR between 2007 and 2017 were obtained via the open-source database MLB Player Analysis Tommy John Surgery List. Other information, such as previous UCLR and pitching videos and graphics, was obtained from other open-source databases. A comprehensive, 2-dimensional, kinesiology-based multicomponent definition of each pitching style was formulated and used to categorize the included pitchers into the TF and DD groups. Statistical comparisons and contrasts were made using chi-square and Pearson correlation tests. Results: Included were 223 MLB pitchers (mean ± SD age, 27.5 ± 3.6 years; body mass index [BMI], 27.6 ± 2.2; throwing velocity, 92.9 ± 2.6 mph [149.5 ± 4.2 km/h]) who underwent UCLR between 2007 and 2017. Of these pitchers, 162 were categorized as TF pitchers (72.6%) and 61 as DD pitchers (27.4%). Pitching velocity for injured pitchers was significantly correlated to BMI ( P < .001). We found no significant associations of pitching style with year of UCLR ( P = .941), BMI ( P = .549), age ( P = .647), handedness ( P = .501), or average pitch velocity ( P = .921). Conclusion: The study findings demonstrated that a higher proportion of UCL-injured MLB pitchers (72.6%) used the TF pitching style. Further research is needed to explore the potential association between pitching style and UCL injury.

Comparison of the “Tall and Fall” Versus “Drop and Drive” Pitching Styles: Analysis of Major League Baseball Pitchers During a Single Season

“…5,12,25 The prevalence of UCLR among MLB pitchers has increased in the past 15 years. 8 In a recent study, 3 we demonstrated that a higher proportion of UCL-injured MLB pitchers who underwent UCLR from 2007 to 2017 used the TF pitching style compared with the DD style (72.6% vs 27.4%, respectively). Nonetheless, it is unknown what proportion of MLB pitchers use the TF and DD pitching styles and whether either of these pitching styles elicits a greater rate of UE injury or UCLR.…”

“…The procedural protocol used to distinguish the TF and DD pitching styles was adapted from our previous study. 3 The pitching style was assessed through the use of pitching videos attained from open media sources. Each video was collected from the 2019 athletic year.…”

“…3 If the pitcher’s drive-leg knee kinematic angle fell between 130° and 140°, their pitching style was determined based on pelvis location (pelvis above [for TF] or in line/below [for DD] the lead knee) (Figure 1, C and D). 3…”

“…Other information, such as UE (shoulder or elbow) injury or surgery during 2019, MLB division and league, and pitching video, were obtained from open-source databases. 3,13,18,20,29 A UE injury was defined as one in which the pitcher was placed on the disabled list after sustaining an elbow or shoulder injury to their dominant throwing arm. 18,20…”

“…7,26,27 In the TF pitching style, the pelvis is higher than the drive-leg knee joint at SFC, resulting in the ball being released at a slightly vertical trajectory off the pitching mound. 3,26,27 The DD pitching style involves the driveleg knee joint assuming a flexed position, which remains below or in line with the pelvis as the pitcher drives forward in a lunge-like position, resulting in a longer, faster stride motion toward home plate. 7,[26][27][28] Both pitching styles seek to maximize pitching velocity and throwing performance.…”