Using Pitch-Tracking Data to Identify Risk Factors for Medial Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2022 Mar 14

PMID 35284587

Authors

Samuel A Cohen

Daniel A Portney

Landon E Cohen

Ioanna Bolia-Kavouklis

Alexander E Weber

Matthew D Saltzman

Affiliations

Soon will be listed here.

Abstract

Background: Approximately 25% of Major League Baseball (MLB) pitchers undergo medial ulnar collateral ligament reconstruction (UCLR) during their careers.

Purpose: To identify risk factors for UCLR that are specific to 2 subgroups of MLB pitchers: right (RHPs)- versus left-handed pitchers (LHPs) and starting (SPs) versus relief pitchers (RPs).

Study Design: Case-control study; Level of evidence, 3.

Methods: We included 109 MLB pitchers who had undergone UCLR between 2007 and 2019 and had sufficient preinjury data in the 3 years before surgery (T3, T2, T1). A 2:1 matched control cohort was selected for comparison. Pitch velocity, release location, and ball movement were compared between the UCLR and control cohorts in both subgroups in the years before surgery (RHPs vs LHPs and SPs vs RPs). Binary logistic regression was used to identify independent risk factors for UCLR.

Results: The mean horizontal release location for the UCLR group was 5.8 cm more lateral than for the control group ( = .028). For all pitchers, every 2.5-cm lateral shift in release location in the years leading up to UCLR equated to a 3.7% increase in the odds of UCLR. For RPs, this risk was more substantial: a 5.8% increase in odds per 2.5 cm. SPs in the UCLR group demonstrated significantly different T1 horizontal release locations compared with SPs in the control group, though not to a statistically significant change over the 3 years before surgery. However, in the 3 years before surgery, the horizontal release location for RPs in the UCLR group moved 2.1 cm more lateral, as compared with 2.7 cm more medial for RPs in the control group ( = .007). For LHPs, a decrease in mean pitch velocity by 1 mph (1.6 km/h) in the years leading up to surgery increased the odds of UCLR by 45%.

Conclusion: Increasing lateralization of release point in the years before surgery increased the risk of UCLR, specifically for relievers. Our findings add to the growing body of evidence that release location is an important variable in analyzing the risk of UCLR in MLB and that risk stratification may be dependent on pitcher characteristics such as position, handedness, and weight.

Citing Articles

Advanced Analytic and Pitch-Tracking Metrics Associated with UCL Surgery in Major League Baseball Pitchers: A Case-Control Study.

Mastroianni M, Kunes J, El-Najjar D, Obana K, Desai S, Morrissette C Orthop J Sports Med. 2025; 13(2):23259671241302432.

PMID: 39906603 PMC: 11789092. DOI: 10.1177/23259671241302432.

Relationship between ball release point variability and pitching performance in major league baseball.

Wakamiya K, Nagamoto H, Yamaguchi R, Okunuki T, Maemichi T, Liu Z Front Sports Act Living. 2024; 6:1447665.

PMID: 39624623 PMC: 11608975. DOI: 10.3389/fspor.2024.1447665.

References

Osbahr D, Cain Jr E, Raines B, Fortenbaugh D, Dugas J, Andrews J . Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players: Minimum 10-Year Follow-up. Am J Sports Med. 2014; 42(6):1333-42. DOI: 10.1177/0363546514528870. View

Fortenbaugh D, Fleisig G, Andrews J . Baseball pitching biomechanics in relation to injury risk and performance. Sports Health. 2012; 1(4):314-20. PMC: 3445126. DOI: 10.1177/1941738109338546. View

Camp C, Tubbs T, Fleisig G, Dines J, Dines D, Altchek D . The Relationship of Throwing Arm Mechanics and Elbow Varus Torque: Within-Subject Variation for Professional Baseball Pitchers Across 82,000 Throws. Am J Sports Med. 2017; 45(13):3030-3035. DOI: 10.1177/0363546517719047. View

Cain Jr E, Andrews J, Dugas J, Wilk K, McMichael C, Walter 2nd J . Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010; 38(12):2426-34. DOI: 10.1177/0363546510378100. View

Melugin H, Leafblad N, Camp C, Conte S . Injury Prevention in Baseball: from Youth to the Pros. Curr Rev Musculoskelet Med. 2018; 11(1):26-34. PMC: 5825337. DOI: 10.1007/s12178-018-9456-5. View

OBrien D, OHagan T, Stewart R, Atanda Jr A, Hammoud S, Cohen S . Outcomes for ulnar collateral ligament reconstruction: a retrospective review using the KJOC assessment score with two-year follow-up in an overhead throwing population. J Shoulder Elbow Surg. 2015; 24(6):934-40. DOI: 10.1016/j.jse.2015.01.020. View

Freehill M, Ebel B, Archer K, Bancells R, Wilckens J, McFarland E . Glenohumeral range of motion in major league pitchers: changes over the playing season. Sports Health. 2012; 3(1):97-104. PMC: 3445183. DOI: 10.1177/1941738110374627. View

Werner S, Murray T, Hawkins R, Gill T . Relationship between throwing mechanics and elbow valgus in professional baseball pitchers. J Shoulder Elbow Surg. 2002; 11(2):151-5. DOI: 10.1067/mse.2002.121481. View

Keller R, Steffes M, Zhuo D, Bey M, Moutzouros V . The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance. J Shoulder Elbow Surg. 2014; 23(11):1591-8. DOI: 10.1016/j.jse.2014.06.033. View

10.

Whiteside D, Martini D, Lepley A, Zernicke R, Goulet G . Predictors of Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers. Am J Sports Med. 2016; 44(9):2202-9. DOI: 10.1177/0363546516643812. View

11.

Whiteley R . Baseball throwing mechanics as they relate to pathology and performance - a review. J Sports Sci Med. 2013; 6(1):1-20. PMC: 3778685. View

12.

Werner S, Fleisig G, Dillman C, Andrews J . Biomechanics of the elbow during baseball pitching. J Orthop Sports Phys Ther. 1993; 17(6):274-8. DOI: 10.2519/jospt.1993.17.6.274. View

13.

Lyman S, Fleisig G, Andrews J, Osinski E . Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002; 30(4):463-8. DOI: 10.1177/03635465020300040201. View

14.

Prodromo J, Patel N, Kumar N, Denehy K, Tabb L, Tom J . Pitch Characteristics Before Ulnar Collateral Ligament Reconstruction in Major League Pitchers Compared With Age-Matched Controls. Orthop J Sports Med. 2016; 4(6):2325967116653946. PMC: 4910396. DOI: 10.1177/2325967116653946. View

15.

Jiang J, Leland J . Analysis of pitching velocity in major league baseball players before and after ulnar collateral ligament reconstruction. Am J Sports Med. 2014; 42(4):880-5. DOI: 10.1177/0363546513519072. View

16.

Seroyer S, Nho S, Bach B, Bush-Joseph C, Nicholson G, Romeo A . The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention. Sports Health. 2012; 2(2):135-46. PMC: 3445080. DOI: 10.1177/1941738110362656. View

17.

Aguinaldo A, Chambers H . Correlation of throwing mechanics with elbow valgus load in adult baseball pitchers. Am J Sports Med. 2009; 37(10):2043-8. DOI: 10.1177/0363546509336721. View

18.

Portney D, Buchler L, Lazaroff J, Gryzlo S, Saltzman M . Influence of Pitching Release Location on Ulnar Collateral Ligament Reconstruction Risk Among Major League Baseball Pitchers. Orthop J Sports Med. 2019; 7(2):2325967119826540. PMC: 6385331. DOI: 10.1177/2325967119826540. View

19.

Portney D, Lazaroff J, Buchler L, Gryzlo S, Saltzman M . Changes in pitching mechanics after ulnar collateral ligament reconstruction in major league baseball pitchers. J Shoulder Elbow Surg. 2017; 26(8):1307-1315. DOI: 10.1016/j.jse.2017.05.006. View

20.

Wymore L, Chin P, Geary C, Carolan G, Keefe D, Hoenecke H . Performance and Injury Characteristics of Pitchers Entering the Major League Baseball Draft After Ulnar Collateral Ligament Reconstruction. Am J Sports Med. 2016; 44(12):3165-3170. DOI: 10.1177/0363546516659305. View