Major League Baseball Health and Injury Tracking System (HITS): A Review of MLB Injuries Documented in the HITS
Bradley A Lezak1, Peter N Chalmers2, Brandon J Erickson3
1NYU Langone Orthopedics, NYU Langone Health, New York, New York, USA.
Background:
The Major League Baseball (MLB) Health and Injury Tracking System (HITS), created in 2010 with the MLB Players Association, was designed to overcome limitations of injured list-based reporting. It serves as a longitudinal injury surveillance platform and electronic medical record across major and minor league players.
Purpose:
To evaluate all publications related to the HITS database to provide an overview of epidemiology, treatment outcomes, and return-to-play (RTP) rates in professional baseball, guiding player safety and performance strategies.
Study Design:
Scoping review; Level of evidence, 4.
Methods:
All peer-reviewed publications utilizing the HITS database (2010-2023) were reviewed under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting epidemiology, surgical versus nonoperative management, and RTP outcomes across upper extremity, lower extremity, spine, and other injuries were synthesized.
Results:
From 2011 to 2016, HITS recorded 49,955 injuries, resulting in 722,176 missed days of play. Pitchers accounted for 39% of injuries, with the upper extremity most affected (39%). Ulnar collateral ligament (UCL) injuries, while the sixth most common, represented the leading cause of surgery (46%) and season-ending injuries (60%). RTP following UCL reconstruction ranged from 73% to 84%, though outcomes declined with revision procedures. Shoulder injuries were also prevalent: labral repairs showed moderate RTP rates (74%-82%), whereas rotator cuff repair yielded poor outcomes (14%-42%), leading to preference for nonoperative care. Lower extremity injuries included hamstring strains, hip/groin injuries, and meniscal pathology, with variable RTP timelines. Core injuries, lumbar spine disorders, and concussions also contributed significantly to time lost. Overall, HITS has informed >40 publications, highlighting variable outcomes by injury type, treatment, and player position.
Conclusion:
The HITS database provides the most comprehensive epidemiologic resource on injuries in professional baseball, identifying high-risk conditions and characterizing management outcomes. RTP success varies widely, with certain injuries such as UCL reconstruction yielding relatively favorable results, while others such as rotator cuff repair remain challenging.
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