Return to Play and Performance After Shoulder Labral Repair in Major League Baseball Players

Return to play (RTP) and return to performance (RTPf) after labral repair in Major League Baseball (MLB) athletes remain poorly defined. Modern advanced analytics allow for a more comprehensive evaluation of postoperative performance.

To evaluate RTP and RTPf using advanced analytic and ball-tracking metrics in MLB pitchers and position players after primary shoulder labral repair.

Cohort study; Level of evidence, 3.

A total of 67 MLB players (39 pitchers, 28 position players) who underwent labral repair between March 1, 2017, and December 1, 2024, were compared with 78 matched control pitchers and 56 matched control position players. RTP rates and timing were recorded for all players. RTPf analysis was performed for athletes with at least 2 seasons of complete pre- and postoperative advanced analytic data, resulting in 17 pitchers and 21 position players included as cases for RTPf analysis. Various traditional, advanced analytic, and ball-tracking metrics were analyzed for the first 2 seasons after return from injury and compared with the season prior to injury. For pitchers, these metrics included advanced analytics measuring the physical quality of pitches, command of the strike zone, and overall pitching ability. Unpaired and paired t tests compared pre- and postoperative performance, along with matched controls.

Overall, 64.2% of all players returned to MLB play, with RTP rates for pitchers significantly lower (43.6% vs 92.9%; P < .05) and longer (493 vs 285 days; P < .05) than for position players. There were no significant differences in any offensive or defensive metric for position players pre- versus postoperatively. For pitchers, there were no significant differences in velocity, spin, movement, arm angle, approach angle, release point, or extension. Postoperatively, pitchers demonstrated significantly decreased workload (eg, innings pitched) and overall value (FanGraphs wins above replacement) for the first season back, returning to <50% of their preinjury baseline. Furthermore, pitchers showed significantly decreased physical quality of pitches, command of the strike zone, and overall pitching ability after shoulder labral repair (P < .05) during the first season back but not during the second.

The prognosis after shoulder labral repair is highly dependent on player role in MLB. Position players generally returned to MLB (92.9%) and recovered baseline performance. In contrast, pitchers faced a guarded prognosis, with only 43.6% returning to MLB and requiring a significantly longer recovery period. For those pitchers who did return, traditional metrics such as velocity and movement were unchanged; however, advanced analytics showed a decline in pitch quality and command as well as reduced workloads and value.