Poster 202. Return to Play and Performance following UCL Reconstruction and Repair in Major League Baseball Position Players

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Objective: Return to play and performance following UCL reconstruction or repair in Major League Baseball (MLB) position players has not been well studied. Modern advanced analytics allow for more accurate evaluation of performance. Therefore, our primary objective is to evaluate return to performance using modern advanced analytics and ball-tracking metrics in MLB position players following UCL surgery in a 10-season period from 2014 to 2023. Our secondary objective was to evaluate incidence and RTP rates in MLB position players, comparing reconstructions versus repairs and providing an up-to-date analysis on career longevity during a period focused on value and advanced analytics. Overall, this study will better inform position players and teams what to expect after UCL surgery using outcomes that drive player evaluation throughout MLB. Methods: A retrospective analysis was performed on all 21 MLB position players who underwent primary UCL reconstruction or repair between March 1, 2014 and August 1, 2024 and reported incidence and return-to-play rates. Return-to-performance analysis was conducted for 18 players who had at least 1 season of post-operative advanced analytic and ball-tracking data, which was compared to pre-operative levels and 36 uninjured matched controls. Performance data was collected for all MLB position players using public sources. Binary logistic regression was conducted to evaluate for any predictive factors of return to performance. Results: Incidence of UCL surgery in MLB position players over the full ten season period (2014 to 2023) was 1.6 ± 0.97 surgeries per season in our cohort, with an even greater average (2.0 ± 0.71 surgeries per season) in the past five full seasons compared to 2014 to 2018 (1.2 ± 1.1 surgeries per season; p=0.21) and 1984 to 2014 (1.1 surgeries per season; p=0.05). ​42.9% returned to play at 9 months, 81.0% at 1 year, and 85.7% at 1.5 years postoperatively, with a mean time of 273 ± 64 days after UCL surgery (Table 2). UCL repairs resulted in 70 less days missed on average compared to UCL reconstructions (p = 0.01). Notably, position players provided significantly less value (fWAR) in the first season after returning, but recovered to provide a similar value by the second season after returning. There was otherwise no differences in any mean offensive or defensive metric when comparing pre-injury to post-operative values. wRC+ was the only identified predictor for returning to performance in fWAR, emphasizing its importance in players recovering their value after surgery. Conclusions: UCL surgery rates in MLB positional players has increased over 75% from 2019 to 2023 compared to the prior 35 seasons. 85% of players returned to play by 1.5 years post-operatively, with UCL repairs returning 2 months earlier on average compared to reconstructions, and all players who received a repair and returned had returned to play returned by 9 months compared to just over 20% of reconstructions. Notably, position players provided significantly less value (fWAR) in the first season after returning, but recovered to provide a similar value by the second season after returning. There was otherwise no differences in any mean offensive or defensive metric when comparing pre-injury to post-operative values. While a majority of players return to performance in most individual metrics, a vast majority of players did not return to full performance in fWAR, wRC+, and OAA combined by 2 seasons, albeit most had returned in two out of three criteria. While sample size was limited, catchers required the most amount of days to return to play and outfielders had significantly decreased wRC+ and OPS+ in the second season following surgery compared to the other position subgroups. wRC+ was the only identified predictor for returning to performance in fWAR, emphasizing its importance in players recovering their value after surgery. Altogether, this study evaluates return to play and performance following UCL surgery in MLB position using several advanced analytic and ball-tracking outcomes for the first time.

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