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Effect of COVID-19 on Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers
Ryan W Paul1, Ali Omari1, Brian Fliegel2
1Rothman Orthopaedic Institute, New York, New York, USA.
Insights
Major League Baseball pitchers faced a nearly 3-fold increased risk of ulnar collateral ligament reconstruction (UCLR) per game following the COVID-19 pandemic. Reduced preseason pitching workloads may have contributed to this rise in UCLR rates.
Area of Science:
- Sports Medicine
- Orthopedic Surgery
- Baseball Analytics
Background:
- The COVID-19 pandemic significantly altered the 2020 Major League Baseball (MLB) season, reducing it to 60 games.
- The impact of this disruption on injury rates, particularly ulnar collateral ligament (UCL) injuries, remained unquantified.
Purpose of the Study:
- To compare ulnar collateral ligament reconstruction (UCLR) rates and pitching workloads in MLB pitchers before and after the COVID-19 pandemic.
- To investigate the relationship between reduced pitching volume and UCLR incidence.
Main Methods:
- A cohort study utilizing publicly available data from January 2017 to December 2020.
- Identified MLB pitchers undergoing UCLR, collecting data on player characteristics, surgery timing, and pitching workload.
- Compared UCLR rates and workload metrics between the pre-pandemic (2017-2019) and pandemic-impacted (2020) seasons.
Main Results:
- While the absolute number of UCLR surgeries remained similar, MLB pitchers were 2.9 times more likely to undergo UCLR per game in 2020 compared to 2017-2019 (P < .001).
- Pitchers undergoing UCLR in 2020 had significantly fewer preseason innings pitched (5.98) than those operated on between 2017-2019 (9.39) (P = .001).
Conclusions:
- MLB pitchers demonstrated a significantly higher per-game rate of UCLR following the COVID-19 lockdown.
- A potential contributing factor to the increased per-game UCLR rates is the reduced preseason pitching workload experienced during the 2020 season.
Background:
The coronavirus disease of 2019 (COVID-19) pandemic led to the suspension and shortening of the 2020 Major League Baseball (MLB) season from 162 to 60 regular season games. The effect of this disruption on injury rates, specifically injury to the ulnar collateral ligament (UCL), has not been quantified.
Purpose/Hypothesis:
The purpose of this study was to compare the rate of UCL reconstruction (UCLR), surgery timing, and pitching workload in MLB pitchers from before and after the COVID-19 pandemic lockdown. We hypothesized that UCLR rates relative to games played would be increased and pitching workload would be decreased in 2020 compared with previous seasons.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
An extensive online search using publicly available data was conducted to identify all MLB pitchers who underwent UCLR between January 1, 2017, and December 31, 2020. Only pitchers who were competing at the MLB level when undergoing reconstruction were included. Player characteristics and surgery date, as well as career and season of surgery pitching workload, were collected for all included pitchers. All data were compared as a pooled sample (2017-2019 vs 2020).
Results:
A similar number of pitchers underwent UCLR during or after the 2020 regular season (n = 18) compared with the 2017-2019 seasons (n = 16, 20, and 16, respectively). However, after accounting for the decrease in games played during the 2020 regular season, an MLB pitcher was 2.9 times more likely to undergo surgery per game after the COVID-19 lockdown compared with the previous years (P < .001). MLB pitchers who underwent surgery in 2020 threw fewer preseason innings than did pitchers who underwent surgery between 2017 and 2019 (5.98 vs 9.39; P = .001).
Conclusion:
MLB pitchers were almost 3 times more likely to undergo UCLR per game after the COVID-19 lockdown. A decreased preseason pitching workload because of the COVID-19 lockdown may have had an effect on per game UCLR rates.
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