Shoulder Injuries in Professional Baseball Batters: Analysis of 3,414 Injuries Over an 8-Year Period.

Purpose: To characterize the shoulder injuries experienced by baseball batters and position players (nonpitchers); to quantify the outcomes of these injuries with respect to time out of play, recurrence, and surgery rates; and to identify any injury patterns that are associated with worse outcomes. Methods: Between 2011 and 2017, all Major League Baseball (MLB) and Minor League Baseball (MiLB) players who sustained shoulder injuries were identified using the MLB Health and Injury Tracking System (HITS). Injuries were included if they were sustained during baseball activity, resulted in at least 1 day missed (DM), and occurred in position players (nonpitchers). Results: Over the study period, a total of 3,414 shoulder injuries occurred in batters, resulting in a sum of 68,808 DM and a mean of 22 DM per injury. Most injuries were a result of acute trauma (n = 2125; 62.2%) with throwing as the predominant activity (n = 1292; 38%). Rotator cuff strain/tears was the most common diagnosis (n = 790; 23.1%), and SLAP tears had the highest season-ending rate (35.3%) and need for surgery (45.1%). There was a lower frequency of surgery (6.2% vs 9.2%; P = .002) and reinjury (2.03% vs 3.62%; P = .007) in the throwing shoulder vs the nonthrowing shoulder. There was an increased frequency of surgery for the front versus the back batting shoulder (8.2% vs 6.2%; P = .031) with similar DM (20.7 vs 22.2; P = .333) and return to play rates (94.0% vs 92.2%; P = .135). Conclusions: During the 7-season study period, there were a total of 3,414 shoulder injuries that resulted in nearly 70,000 days of out of play in professional baseball position players/batters (nonpitchers). Although pitchers were intentionally excluded from the analysis, throwing was still the most common mechanism of injury, and rotator cuff injuries were the most common injury. Labral tears were the most likely injury to be season ending and require surgery. Clinical Relevance: This study is meant to help determine characteristics of shoulder injuries that occur in non-pitchers by focusing on professional baseball batters and position players. This information could be helpful to sports medicine practitioners and shoulder specialists to better prognosticate injury recovery.

Correlation of Rehabilitation and Throwing Program Milestones With Outcomes After Ulnar Collateral Ligament Reconstruction: An Analysis of 717 Professional Baseball Pitchers.

BACKGROUND: There remains room for improvement in surgical outcomes after medial ulnar collateral ligament reconstruction (MUCLR) in professional pitchers. The role and influence of postoperative rehabilitation on the outcomes of MUCLR are unknown. There is a paucity of clinical data in the current literature comparing the success of various postsurgical rehabilitation protocols after MUCLR. PURPOSE: To summarize the current rehabilitation process for professional pitchers recovering from MUCLR, evaluates what player and surgical factors correlate with outcomes, and determines whether rehabilitation timing and milestones correlate with successful outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: 717 professional baseball pitchers who underwent MUCLR between 2010 and 2016 were identified and included in the analysis. Player characteristics evaluated included age at the time of surgery, throwing side dominance, primary pitching role (starter vs reliever), and level of play (MLB, AAA, AA, A). Surgical factors studied included date of surgery, graft type (palmaris longus autograft vs gracilis autograft), and surgical technique (figure of 8 vs docking vs other). The rehabilitation and throwing progression details were as follows: initiation date; first throw date; dates to start throwing from various distances; longest distance thrown; first flat ground throw date; first mound throw date; and first live batting practice (BP) date. The primary outcomes of interest were the ability to return to play at any level (RTP), the ability to return to the same level (RSL), and the time to RTP/RSL. RESULTS: On average, pitchers threw a baseball for the first time 4.9 months after surgery, with a broad range (2.8-14.9 months). For the 675 (94%) pitchers who were able to progress to mound throwing, the first throws off a mound occurred at a mean of 9.4 months after surgery. Before progressing to the mound, the mean longest long-toss distance reached was 137.5 feet, with a broad range (105-300 feet). A high variation in the time to RTP (7.6-53.9 months) and RSL (8.6-60.7 months) was noted. A total of 599 (84%) pitchers were able to RTP at a mean time of 14.9 ± 4.9 months after surgery (range, 7.6-53.9 months). Also, 528 (74%) pitchers were able to RSL after MUCLR at a mean of 17.4 ± 7 months (range, 8.6-60.7 months) postoperatively. Age was the most significant predictor of RTP (hazard ratio [HR], 1.03 [95% CI, 1.01-1.05]; P = .01) and RSL (HR, 0.96 [95% CI, 0.93-0.99]; P < .01). For every 1-year increase in age, there was a 3% increase in the chance of RTP. Conversely, for every 1-year decrease in age, there was a 4% increase in the chance of RSL. MLB players were more likely to RTP (HR, 1.39 [95% CI, 1.18-1.63]; P < .01) but not necessarily to RSL (HR, 0.90 [95% CI, 0.75-1.08]; P = .24). The time from surgery to any of the rehabilitation milestones of interest (first throw, first flat ground pitching, first mound throwing, and first live BP) did not correlate with RTP or RSL (all, P >.05). The same was true for the greatest long-toss distance thrown before transitioning to the mound. CONCLUSION: Significant variability in the postoperative rehabilitation protocols after MUCLR was observed in 717 professional baseball pitchers. The timing of achievement of throwing progression and rehabilitation milestones postoperatively varied widely but did not correlate with outcomes. Player characteristics-except for player age and professional pitching level-did not correlate with RTP and RSL outcomes. Older pitchers and MLB pitchers were more likely to RTP, but younger players were more likely to RSL. Surgical factors did not correlate with rehabilitation outcomes.

Are Baseball Statistics an Appropriate Tool for Assessing Return to Play in Injured Pitchers? Analysis of Statistical Variability in Healthy Players.

BACKGROUND: Basic pitcher statistics have been used to assess performance in pitchers after injury or surgery without being validated. Even among healthy pitchers, the normal variability of these parameters has not yet been established. PURPOSE: To determine (1) the normal variability of basic and advanced pitcher statistics in healthy professional baseball pitchers and (2) the minimum pitches needed to predict these parameters. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Publicly available data from the MLB Statcast and PITCHf/x databases were used to analyze MLB pitchers during the 2015 and 2016 seasons who recorded a minimum of 100 innings without injury. Basic and advanced baseball pitcher statistics were analyzed. The variability of each parameter was assessed by computing the coefficient of variation (CV) between individual pitchers and across all pitchers. A CV <10 was indicative of a relatively constant parameter, and parameters with a CV >10 were generally considered inconsistent and unreliable. The minimum number of pitches needed to be followed for each variable was also analyzed. RESULTS: A total of 118 pitchers, 55 baseball-specific statistical metrics (38 basic and 17 advanced), and 7.5 million pitches were included and analyzed. Of the 38 basic pitcher statistics, only fastball velocity demonstrated a CV <10 (CV = 1.5), while 6 of 17 (35%) advanced metrics demonstrated acceptable consistency (CV <10). Release position from plate and velocity from the plate were the 2 most consistent advanced parameters. When separated by pitch type, these 2 parameters were the most constant (lowest CV) across every pitch type. CONCLUSION: We recommend against utilizing nonvalidated statistical measures to assess performance after injury, as they demonstrated unacceptably high variability even among healthy, noninjured professional baseball pitchers. It is our hope that this study will serve as the foundation for the identification and implementation of validated pitcher-dependent statistical measures that can be used to assess return-to-play performance after injury in the future.

Short-Term Trends in Elbow Ulnar Collateral Ligament Surgery in Collegiate Baseball Players: An Analysis of 25,587 Player-Years.

BACKGROUND: Trends over time in the incidence of ulnar collateral ligament (UCL) surgeries in National Collegiate Athletic Association Division I baseball players are currently unknown. PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the trends in UCL surgeries over 3 years in Division I baseball programs. We hypothesized that surgical injuries would be consistently high over the course of the study. STUDY DESIGN: Descriptive epidemiology study. METHODS: Athletic trainers from Division I baseball programs were invited to participate in an electronic survey over 3 seasons. A total of 155 baseball programs agreed to participate in 2017, 294 programs participated in 2018, and 296 programs participated in 2019. After each of the 3 collegiate baseball seasons, the athletic trainer from each program entered anonymous, detailed descriptive data and surgical information on injured players into a secured database. RESULTS: During the 3 years of this study, 100% of the enrolled programs successfully completed the survey (155/155 in year 1, 294/294 in year 2, and 296/296 in year 3). This registry of 745 completed surveys over 3 years represented 25,587 player-years from Division I collegiate baseball. The percentage of programs with at least 1 UCL surgery during this time was 57% in 2017, 51% in 2018, and 49% in 2019. The majority of these players were pitchers (84% overall from the 3 years). Seniors underwent a significantly lower percentage of the UCL surgeries (8% in 2017, 10% in 2018, and 13% in 2019) than did underclassmen. Surgeries were performed most often in-season and least often during the preseason. A slight majority of players undergoing surgery originated from warm-weather states, but the number of these players was never significantly higher than was the number of players from cold-weather states. Most surgeries performed each year were UCL reconstruction, but the percentage of UCL repair with ligament augmentation increased each year (10% UCL repairs in 2017, 20% in 2018, and 25% in 2019). CONCLUSION: UCL injuries requiring surgery were found to be a major source of morbidity in Division I collegiate baseball, supporting our hypothesis. This study can serve as a baseline for tracking long-term trends in UCL surgeries in collegiate baseball.

Examining Batting Performance After a Sports-Related Concussion Among Major League Baseball Position Players.

BACKGROUND: An ongoing challenge in sports-related concussion (SRC) is determining full recovery. This study examines performance metrics in baseball after an SRC and provides a template for assessment of return-to-performance parameters. PURPOSE: To determine whether batting performance returns to baseline after an SRC. STUDY DESIGN: Descriptive epidemiological study. METHODS: Participants were all Major League Baseball (MLB) position players with confirmed SRCs that occurred during the 2011-2015 seasons. A retrospective review and assessment of performance metrics before and after injury were conducted as defined relative to the number of plate appearances (PAs) to yield reliable performance statistics. Seven batting metrics were considered as outcomes in longitudinal regressions: batting average, on-base percentage, slugging percentage, on-base plus slugging, bases on balls, strikeouts, and home runs. Metrics were calculated for each player 60, 30, and 14 days before their SRCs, as well as for the 14, 30, and 60 days after returning to play. Other variables controlled for included defensive position, player age at the time of SRC, number of days missed, mechanism of injury, whether the player completed a rehabilitation stint, and year in which the mild traumatic brain injury (MTBI) occurred (2011-2015). RESULTS: A total of 77 MTBI case events occurred in MLB position players over 5 seasons. These injuries resulted in a mean 11.4 days lost to injury. For all performance metrics using 60 or 30 days before MTBI as baseline, no statistically significant differences were found in batting performance. In total, 63 events met PA criteria before injury. Varying the PA cutoff thresholds to be more inclusive or more restrictive yielded similar regression results. For the 48 events that met PA criteria before and after injury, most performance metrics showed no significant performance change after MTBI and, in some events, a slight though mostly nonsignificant performance improvement after MTBI. CONCLUSIONS: MLB position players who are medically cleared to return to play after an SRC perform at the same offensive performance levels as their preinjury statistics when an adequate number of PAs is used to compare performance before and after injury.

Epidemiology and Impact of Hand and Wrist Injuries in Major and Minor League Baseball.

Background: Professional baseball players are at risk of acute and chronic injuries to their upper extremities. Methods: Major League Baseball's Health and Injury Tracking System, a prospective injury surveillance system, was used to identify and characterize all hand and wrist injuries sustained by all Major League Baseball (MLB) and Minor League Baseball (MiLB) players during the pre-, regular, and postseason throughout 2011-2016. Injuries were included if they resulted in at least 1 day out of play and were sustained during standard baseball activities. Days missed were defined as the time between injury and the first time in which a player was cleared to return to play. Results: During the study period, there were 4478 hand and 1748 wrist injuries throughout MLB and MiLB, which resulted in a total of 105 246 days out of play. This was equivalent to the length of 575 individual MLB player seasons, and the mean days missed per injury was 17 days. Most injuries were traumatic in nature, with 43% (n = 2672) of players injured after being hit by a baseball that mainly occurred during batting (n = 2521; 40%). Injuries that most frequently required surgical intervention were hook of hamate fractures (72%) and scaphoid fractures (60%). Conclusions: Understanding the epidemiology and impact of hand and wrist injuries in MLB and MiLB players may lead to improved management of these injuries and reduce time away from play. Most importantly, preventive measures and/or enhanced protective gear may be developed to minimize these types of injuries in MLB and MiLB.

Preventing Concussions From Foul Tips and Backswings in Professional Baseball: Catchers' Perceptions of and Experiences With Conventional and Hockey-Style Masks.

OBJECTIVE: To understand catchers' preferences for mask type and perceptions regarding safety, comfort, and fit, and determine whether mask type is correlated with self-reported concussion and related symptoms after impacts from foul tips or backswings. DESIGN: Cross-sectional study. SETTING: Survey of active baseball catchers. PARTICIPANTS: Professional baseball catchers. INTERVENTION: From May 1, 2015, to June 30, 2015, an online survey was administered in English and Spanish to all Major and Minor League catchers (n = 836). MAIN OUTCOME MEASURES: Survey items addressed the type of mask routinely and previously used (conventional or hockey style); brand and material (steel or titanium); perceptions regarding safety, comfort, and fit; and experiences with concussions. RESULTS: The sample consisted of 596 catchers of which 26% reported being diagnosed with a concussion. Some concussions occurred from non-baseball activities, such as car accidents or off the field incidents. For those that occurred playing baseball, 35% resulted from a foul tip. Once catchers entered professional baseball, the use of a conventional mask rose significantly: 71% of catchers reported wearing conventional-style masks, and 30% hockey-style masks at the time the survey was conducted (P < 0.05). Both conventional and hockey-style mask wearers significantly selected hockey-style masks as providing better overall safety and protection than conventional masks (P < 0.05). CONCLUSIONS: This research supports foul tips as an important cause of concussion in catchers and provides important information about preferences among catchers for masks that are not perceived as the safest and strongest. Future research should supplement these data by conducting laboratory testing to determine which masks are stronger and by collecting qualitative data to explore why some players are more likely to wear a mask type that they perceive as offering less safety or protection.

Players' perspectives on successfully returning to professional baseball after medial ulnar collateral ligament reconstruction.

BACKGROUND: As the incidence of ulnar collateral ligament reconstruction (UCLR) surgery continues to rise, an improved understanding of baseball pitchers' perspectives on the postoperative recovery process and return to pitching is needed. The purpose of this study was to analyze pitchers' perspectives on recovery after UCLR. METHODS: dDuring the 2018 baseball season, an online questionnaire was distributed to the certified athletic trainers of all 30 Major League Baseball (MLB) organizations. These athletic trainers then administered the survey to all players within their organization including MLB and 6 levels of Minor League Baseball. MLB or Minor League Baseball pitchers who had previously undergone UCLR and participated in a rehabilitation program (or were currently participating in one at time of the survey) were included in the study. RESULTS: There were 530 professional pitchers who met inclusion criteria. The majority (81%) of pitchers began rehabilitation within 2 weeks of surgery, with 51% beginning within 1 week. The majority of pitchers began a long-toss throwing program at 5 and 6 months after surgery (27% and 21%), with 52% making their first throw off a mound between 7 and 9 months. The number of pitchers who participated in a weighted ball throwing program decreased significantly after surgery (20%-11%, P < .001). After UCLR, 56% of pitchers reported no changes regarding pitching mechanics or types of pitches thrown, 42% reported changed mechanics, and only 3% either decreased or stopped throwing a certain pitch type. Overall, 54% believed that their current throwing velocity was faster than their velocity before ulnar collateral ligament injury. Twenty percent of pitchers reported experiencing a setback that resulted in temporary stoppage of their rehabilitation program, the most common reason being flexor tightness or tendonitis (53%). Seventy-six percent reported that they were not concerned about sustaining another elbow injury; however, significantly less (61%; P < .001) stated that they would have UCLR again if necessary. CONCLUSIONS: Although UCLR is generally reported to have excellent clinical outcomes, 20% of pitchers experienced a significant setback during their rehabilitation and only 61% of pitchers, having gone through UCLR and the subsequent recovery, would be willing to undergo revision surgery and repeat the rehabilitation process if it were to become necessary. In addition, 42% of pitchers felt that they had to alter their throwing mechanics to return to pitching. Surgeons and athletic trainers should aim to understand the UCLR recovery process from the pitchers' perspective to better counsel future patients recovering from UCLR.

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

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.

Variability in Baseball Throwing Metrics During a Structured Long-Toss Program: Does One Size Fit All or Should Programs Be Individualized?

BACKGROUND: The variability of throwing metrics, particularly elbow torque and ball velocity, during structured long-toss programs is unknown. HYPOTHESES: (1) Elbow torque and ball velocity would increase as throwers progressed through a structured long-toss program and (2) intrathrower reliability would be high while interthrower reliability would be variable. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 3. METHODS: Sixty healthy high school and collegiate pitchers participated in a structured long-toss program while wearing a validated inertial measurement unit, which measured arm slot, arm velocity, shoulder rotation, and elbow varus torque. Ball velocity was assessed by radar gun. These metrics were compared within and between all pitchers at 90, 120, 150, and 180 ft and maximum effort mound pitching. Intra- and interthrower reliabilities were calculated for each metric at every stage of the program. RESULTS: Ball velocity significantly changed at each progressive throwing distance, but elbow torque did not. Pitching from the mound did not place more torque on the elbow than long-toss throwing from 120 ft and beyond. Intrathrower reliability was excellent (intraclass correlation coefficient >0.75) throughout the progressive long-toss program, especially on the mound. Ninety-one percent of throwers had acceptable interthrower reliability (coefficient of variation <5%) for ball velocity, whereas only 79% of throwers had acceptable interthrower reliability for elbow torque. CONCLUSION: Based on trends in elbow torque, it may be practical to incorporate pitching from the mound earlier in the program (once a player is comfortable throwing from 120 ft). Ball velocity and elbow torque do not necessarily correlate with one another, so a degree of caution should be exercised when using radar guns to estimate elbow torque. Given the variability in elbow torque between throwers, some athletes would likely benefit from an individualized throwing program. CLINICAL RELEVANCE: Increased ball velocity does not necessarily equate to increased elbow torque in long-toss. Some individuals would likely benefit from individualized long-toss programs for rehabilitation.

Hamstring Injury Trends in Major and Minor League Baseball: Epidemiological Findings From the Major League Baseball Health and Injury Tracking System.

BACKGROUND: Hamstring strains are the most common injury for professional baseball players and can result in significant time on the disabled list. To date, no study has reported the current trends in hamstring strains in professional baseball. HYPOTHESIS: Professional baseball players would have an increased incidence of hamstring strains from 2011 through 2016. STUDY DESIGN: Descriptive epidemiology study. METHODS: Injury data were prospectively collected from 2011 through 2016 for every Major League Baseball (MLB) and Minor League Baseball (MiLB) team and was recorded in the MLB Health and Injury Tracking System. Data collected for this study included date of injury, activity during injury, time lost, primary injury or reinjury status, and imaging findings as well as player demographic information related to level of play, age, and position for all hamstring injury events. Injury rates were reported as hamstring injuries per number of games. RESULTS: From 2011 to 2016, there were 2633 hamstring strains in professional baseball players. The rate of hamstring strains increased in MLB from a low of 1 injury every 39 games in 2011 to a high of 1 injury every 30 games in 2016. In MiLB, there were 2192 hamstring strains, with 1 injury every 35 games in 2011 compared with 1 injury every 30 games in 2016. The majority of injuries occurred in the infielder positions (37.5%) and resulted from base running (>50%), most commonly from home to first base. The most common hamstring injury was a grade 2 injury to the distal biceps femoris. The mean time missed after a hamstring injury was 14.5 days. Grade 3 and grade 2 hamstring strains resulted in significantly more days missed compared with grade 1 injuries (P = .005 and P = .002, respectively). The rate of recurrent hamstring injuries was 16.3% for MLB and 14.2% for MiLB. Recurrent hamstring injuries resulted in more time lost than primary injuries (mean, 16.4 vs 14.5 days, respectively; P = .02). A total of 42 injuries were treated with platelet-rich plasma, and 19 were treated with surgery. The number of injuries treated with platelet-rich plasma increased in successive years. CONCLUSION: The rate of hamstring strains in professional baseball players has increased over the past 6 years and has resulted in a significant loss of playing time. Study results indicated that these injuries are affected by injury characteristics, position played, running to first base, seasonal timing, and history of hamstring injuries.

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes.

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction of the elbow is commonly performed on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. PURPOSE: To provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS, and surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play [RTP] rates, RTP times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (docking vs modified Jobe) and graft sources (palmaris longus autograft vs hamstring autograft). RESULTS: A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1424 days (47 months) after their primary surgery. A trend was seen toward increasing numbers of revision surgeries over time (R 2 = 0.441; P = .104). The most commonly used tunnel configuration was the modified Jobe technique (n = 41; 59.4%), and the most commonly used graft was hamstring autograft (n = 34; 49.3%). A majority (76.6%) of pitchers achieved RTP, and 55.3% were able to return to the same level of play. Mean time to RTP was 436 days (14.5 months) for players with a palmaris longus autograft versus 540 days (18 months) for those with a hamstring autograft (P = .108). Further, the mean time to RTP was 423 days (14 months) for the docking technique versus 519 days (17 months) for the modified Jobe technique (P = .296). Similar rates of subsequent injuries and surgeries were noted between the 2 revision techniques and 2 most commonly used graft constructs. CONCLUSION: Revision UCL reconstruction showed relatively high RTP rates (77%), but only 55% of players returned to their same level of play. Mean time to RTP was shorter than that found in other, smaller investigations. Although general trends were seen toward decreased time to RTP for the docking technique and palmaris longus autograft, these differences did not reach statistical significance.

Baseball Pitchers' Perceived Effort Does Not Match Actual Measured Effort During a Structured Long-Toss Throwing Program.

BACKGROUND: During rehabilitation throwing programs, baseball players are commonly asked to throw at reduced levels of effort (ie, 50% effort, 75% effort, etc) to moderate stress to healing tissues. It is currently unknown how changes in players' perceived exertion compares with changes in actual exertion during structured long-toss programs. PURPOSE: To determine whether decreased effort correlates with decreased throwing metrics, whether metrics decrease proportionally with reductions in perceived effort, and to quantify intrathrower variability. STUDY DESIGN: Descriptive laboratory study. METHODS: Sixty male high school and collegiate baseball pitchers participated in a structured throwing program. A motusBASEBALL sleeve was worn by all players, which measured elbow varus torque, arm velocity, arm slot, and shoulder rotation. Ball velocity was measured with a radar gun. Each pitcher threw 5 throws a distance of 120 ft with 3 efforts: maximum effort, 75% effort, and 50% effort. Throwing metrics were compared among the 3 levels of effort to see if each 25% decrease resulted in proportional decreases in elbow varus torque and ball velocity. Intrathrower variability was determined for each throwing metric at each degree of effort. RESULTS: All throwing metrics decreased as players decreased their perceived effort (P < .001). However, these observed decreases were much smaller in magnitude than the decreases in perceived effort. During the 75% effort throws, elbow varus torque was only reduced to 93% of maximum and velocity dropped to 86% of maximum. Similarly, for the 50% effort throws, elbow varus torque remained 87% of max effort torque, while velocity remained 78% of max. Intrathrower reliability was considered excellent for most metrics (intraclass correlation coefficient, >0.75). CONCLUSION: For every 25% decrease in perceived effort, elbow varus torque only decreased 7% and velocity only decreased 11%. Thus, when players throw at what they perceive to be reduced effort, their actual throwing metrics do not decrease at the same rate as their perceived exertion. CLINICAL RELEVANCE: Measured effort decreased with decreasing perceived effort, but these were not proportional. This has significant implications for physical therapists, physicians, trainers, coaches, and athletes to understand and monitor elbow stress during the rehabilitation process.

Analysis of Non-Game Injuries in Major League Baseball.

BACKGROUND: Numerous studies have investigated injuries and treatments in the baseball athlete. The majority of these studies have focused on the throwing shoulder and elbow. However, more recent literature is reporting injuries to other regions in this cohort, including the knee, head, hip, and hamstring. PURPOSE/HYPOTHESIS: The purpose of the current study was to determine the number and type of injuries in Major League Baseball (MLB) and Minor League Baseball (MiLB) players that do not occur during the actual game but are related to baseball participation. Our hypothesis was that there would be a substantial number of injuries that occurred in professional baseball players during non-game situations. STUDY DESIGN: Descriptive epidemiological study. METHODS: Deidentified, anonymous data were collected from the 2011 through 2016 seasons from the MLB Health and Injury Tracking System (HITS) medical record database. All injuries that were identified as a primary diagnosis and resulted in at least 1 day out of play from both MLB and MiLB were examined. Injuries were categorized as occurring during the game ("game" injuries) or not during the game. A "non-game" injury was defined as occurring at any time other than during the scheduled game from the first to last pitch. RESULTS: There were 51,548 total injuries in MLB and MiLB players from 2011 to 2016, almost 40% of which were attributed to non-game-related injuries (n = 19,201; 37.2%). The remainder occurred during a game (n = 32,347; 62.8%). A significantly greater percentage of non-game injuries were season ending (10.8%) compared with the percentage of game-related season-ending injuries (8.4%) (P < .0001). Pitchers had significantly more non-game-related injuries than game-related injuries (P < .0001). CONCLUSION: A large number of injuries occur in professional baseball outside of actual games. MiLB players, specifically pitchers, are particularly at risk for these types of injuries. It is feasible that the overall injury rate in professional baseball players could be reduced by analyzing these injuries in more detail to develop prevention strategies.

Getting Hit by Pitch in Professional Baseball: Analysis of Injury Patterns, Risk Factors, Concussions, and Days Missed for Batters.

BACKGROUND: Although batters are frequently hit by pitch (HBP) in baseball, the effect of HBP injuries remains undefined in the literature. PURPOSE: To determine the effect of HBP injuries in terms of time out of play, injury patterns resulting in the greatest time out of play, and the value of protective gear such as helmets and elbow pads. STUDY DESIGN: Descriptive laboratory study. METHODS: Based on the Major League Baseball (MLB) Health and Injury Tracking System, all injuries to batters HBP during the 2011-2015 MLB and Minor League Baseball (MiLB) seasons were identified and analyzed. Video analysis was performed on all HBP events from the 2015 MLB season. Multivariate stepwise regression analysis was utilized to determine the predictive capacity of multiple variables (velocity, pitch type, location, etc) on injury status and severity. RESULTS: A total of 2920 HBP injuries resulted in 24,624 days missed (DM) over the 5 seasons. MLB HBP injuries occurred at a rate of 1 per 2554 plate appearances (1 per 9780 pitches thrown). Mean DM per injury were 8.4 (11.7 for MLB vs 8.0 for MiLB, P < .001). Surgery was required for 3.1% of MLB injuries and 1.2% of MiLB injuries ( P = .005). The most common body regions injured were the hand/fingers (n = 638, 21.8%), head/face (n = 497, 17.0%), and elbow (n = 440, 15.7%), and there were 146 (5.0%) concussions. Injury rates and mean DM correlated with velocity in a near linear fashion. Players hit in the head/face (odds ratio, 28.7) or distal upper extremity (odds ratio, 6.4) were more likely to be injured than players HBP in other locations. Players with an unprotected elbow missed 1.7 more days (95% CI, -4.1 to 7.6) than those with an elbow protector ( P = .554) when injured after being HBP. CONCLUSION/CLINICAL RELEVANCE: Although HBP injuries occur infrequently in the course of normal play, they collectively represent a significant source of time out of play. The most common body regions injured include the hands/fingers and head/face, and batters hit in these locations are significantly more likely to be injured. After contusions, concussions were the most common injury diagnosis.

Summative Report on Time Out of Play for Major and Minor League Baseball: An Analysis of 49,955 Injuries From 2011 Through 2016.

BACKGROUND: Recent epidemiologic reports have demonstrated rising injury rates in Major League Baseball (MLB) and Minor League Baseball (MiLB). Although several studies have recently been published on specific injuries, the majority of injuries have not yet been formally studied. PURPOSE: The purpose of this study is to (1) generate a summative analysis of all injuries that occur in MLB and MiLB, (2) identify the 50 most common injuries, and (3) generate focused reports and fact sheets on the characteristics of each of those diagnoses. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The MLB Health and Injury Tracking System was used to identify injuries occurring in MLB and MiLB players from 2011 to 2016. Injuries were defined as those that occurred during normal baseball activity and resulted in at least 1 day out of play. A multitude of player and injury characteristics were analyzed, and detailed reports of the 50 most commonly occurring injuries were generated. RESULTS: A total of 49,955 injuries occurred during the study period; 45,123 were non-season ending, and they resulted in 722,176 days out of play. The mean (median) days missed per injury was 16 (6) days. Overall, 39.1% of all injuries occurred in pitchers. The upper extremity was involved in 39% of injuries, while 35% occurred in the hip/groin/lower extremity. Surgery was required in 6.5% of cases, and 9.7% of injuries were season ending. Hamstring strains were the most common injury (n = 3337), followed by rotator cuff strain/tear (n = 1874), paralumbar muscle strain (n = 1313), biceps tendinitis (n = 1264), oblique strain (n = 1249), and elbow ulnar collateral ligament injury (n = 1191). The diagnoses that were most likely to end a player's season were elbow ulnar collateral ligament injury (60% season ending) and superior labrum anterior and posterior tear (50.9% season ending). CONCLUSION: Contrary to prior reports relying on disabled list data, the annual number of injuries in professional baseball remained steady from 2011 to 2016. Similar trends were noted for the annual number of days missed and mean days missed per injury. Although the mean days missed per injury was high (16), the median was much lower at 6 days.

Incidence of Elbow Ulnar Collateral Ligament Surgery in Collegiate Baseball Players.

BACKGROUND: Recent reports have highlighted the progressive increase in the incidence of ulnar collateral ligament (UCL) injuries to the elbow in baseball players of all levels. However, knowledge of the incidence and other epidemiological factors regarding UCL injuries, specifically in college baseball players, is currently lacking. PURPOSE: To evaluate, over a period of 1 year, the incidence of UCL injuries requiring surgery in National Collegiate Athletic Association (NCAA) Division I baseball programs. STUDY DESIGN: Descriptive epidemiology study. METHODS: A total of 155 Division I collegiate baseball programs agreed to participate in the study. Demographics (position, year, background [location of high school]) for all players on these rosters were obtained from public websites. At the conclusion of the 2017 collegiate baseball season, the athletic trainer for each program entered anonymous, detailed information on injured players through an electronic survey into a secured database. RESULTS: All 155 teams enrolled in the study completed the electronic survey. Of the 5295 collegiate baseball players on these rosters, 134 underwent surgery for an injured UCL (2.5% of all eligible athletes), resulting in a team surgery rate of 0.86 per program for 1 year. These 134 players came from 88 teams, thus 56.8% of the study teams underwent at least 1 surgery during the year. The surgery rate was 2.5 per 100 player-seasons for all players and was significantly higher among pitchers (4.4/100 player-seasons) than nonpitchers (0.7/100 player-seasons). The surgery rate was also significantly higher in underclassmen (3.1/100 player-seasons among freshmen and sophomores) than upperclassmen (1.9/100 player-seasons among juniors and seniors) (incidence rate ratio, 1.7; 95% CI, 1.1-2.4). Players from traditionally warm-weather states did not undergo UCL surgery at a significantly different rate from players from traditionally cold-weather states (2.7/100 player-seasons vs 2.1/100 player-seasons, respectively). Nearly half of surgeries (48.5%) were performed during the baseball season. CONCLUSION: The incidence of UCL surgeries in NCAA Division I collegiate baseball players represents substantial morbidity to this young athletic population. Risk factors for injuries requiring surgery include being a pitcher and an underclassman. Awareness of these factors should be considered in injury prevention programs. Furthermore, this initial study can serve as a foundation for tracking these surgical injuries in future years and then identifying trends over time.

Epidemiology of ulnar collateral ligament reconstruction in Major and Minor League Baseball pitchers: comprehensive report of 1429 cases.

BACKGROUND: The primary purpose of this work is to provide an epidemiologic report on every known ulnar collateral ligament (UCL) reconstruction performed in professional baseball with a special focus on outcomes and survivorship. METHODS: Three resources, including the Major League Baseball (MLB) injury tracking system, were combined and cross-referenced to identify all known professional baseball pitchers who had ever undergone UCL reconstruction from 1974 to 2016. Variables analyzed included injury date, surgery date, return to play rates, time out of play, and revision status. Trends over time were analyzed collectively and by level of play at the time of surgery. A minimum of 2 years of follow-up was required for return to play analysis. RESULTS: We identified 1429 UCL reconstructions. The annual rate of primary and revision UCL reconstructions rose significantly (P < .001). Most players (83.7%) returned to any level of play at a mean of 435 days, whereas 72.8% (P < .001) returned to their prior level at a mean of 506 days. Major League Baseball players were more likely than Minor League Baseball players to return to any level (94.6% vs. 79.0%, P < .001) and their prior level of performance (80.0% vs. 69.1%, P = .04). The mean overall survivorship free from revision and still playing was 3.8 years (3.9 for primary vs. 2.9 for revisions, P = .018). The revision rate was 6.7% and was higher for Major League Baseball (9.4%) vs. Minor League Baseball (5.2%, P = .004). CONCLUSIONS: This study represents the most robust epidemiologic report of UCL reconstruction in baseball to date, and a multitude of novel findings are reported.

Following ulnar collateral ligament reconstruction, professional baseball position players return to play faster than pitchers, but catchers return less frequently.

BACKGROUND: Although much as been done to characterize trends of medial ulnar collateral ligament (UCL) reconstruction in pitchers, outcomes in position players (PPs) (non-pitchers) remain undefined in the current literature. METHODS: Three resources were combined to identify all known Major League Baseball and Minor League Baseball (MiLB) PPs who have ever undergone UCL reconstruction. A multitude of player and surgical variables were included. Trends over time were analyzed collectively, based on level of play, revision status (primary vs revision), and position. Additional comparisons were made with a known cohort of professional baseball pitchers having undergone UCL reconstruction. RESULTS: We identified 168 UCL reconstructions in professional PPs. The annual rate of primary UCL reconstruction rose significantly from 1984 to 2015 (P < .001), and the proportion of cases performed in MiLB PPs (vs Major League Baseball PPs) increased steadily (P < .001). Of PPs, 75.5% returned to play at any level at a mean of 342 days. Catchers demonstrated the lowest return-to-play (RTP) rate (58.6%) compared with infielders (75.6%) and outfielders (88.9%). The overall revision rate was low, at 4.8%. Compared with pitchers, PPs demonstrated a lower rate of RTP (75.5% for PPs vs 83.7% for pitchers, P = .040) but shorter RTP times for those able to return (342 days for PPs vs 435 days for pitchers, P < .001). CONCLUSIONS: The incidence of UCL reconstruction in PPs continues to rise, a trend that is significantly more pronounced at the MiLB level. Although PPs (particularly catchers) are less likely to return to professional baseball compared with pitchers, those who are able to RTP do so more rapidly.

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

BACKGROUND: In recent years, there has been a dramatic rise in the annual number of ulnar collateral ligament (UCL) reconstructions performed in amateur baseball pitchers. Accordingly, increasing numbers of players are entering professional baseball having already undergone the procedure; however, the effect of prior UCL reconstruction on future success remains unknown. PURPOSE: (1) To provide an epidemiologic report on baseball players who undergo UCL reconstruction before being selected in the Major League Baseball (MLB) Draft, (2) to define the outcomes in terms of statistical performance, and (3) to compare these results with those of matched controls (ie, non-UCL reconstruction). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The MLB Amateur Draft Database was queried to identify all drafted pitchers who underwent UCL reconstruction before being drafted. For each pitcher drafted from 2005 to 2014 with prior UCL reconstruction, 3 healthy controls with no history of elbow surgery were randomly identified for matched analysis. A number of demographic and performance comparisons were made between these groups. RESULTS: A total of 345 pitchers met inclusion criteria. The annual number of pitchers undergoing predraft UCL reconstructions rose steadily from 2005 to 2016 ( P < .001). For matched control analysis, 252 pitchers with a UCL reconstruction and a minimum 2-year follow-up (drafted between 2005 and 2014) were matched to 756 controls (non-UCL reconstruction). As compared with the non-UCL reconstruction group, pitchers who underwent predraft UCL reconstruction reached the MLB level with greater frequency (20% vs 12%, P = .003), and their MLB statistical performances were similar for all measures. Compared with all other pitchers drafted during that period, players who had a predraft UCL reconstruction demonstrated an increased likelihood of reaching progressive levels of play (Full Season A, AA, and MLB) within a given time frame ( P < .05 for all). CONCLUSION: The number of UCL reconstructions performed in amateur baseball players before the draft increased year over year for the entire study period. Professional pitchers who underwent UCL reconstruction as amateurs appear to perform at least as well as, if not better than, matched controls without elbow surgery.