Poster 194. Pitch-Tracking Risk Factors and Warning Signs for Ulnar Collateral Ligament Injuries in Major League Baseball Pitchers

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Objective: Ulnar collateral ligament (UCL) injuries remain highly prevalent among baseball pitchers across all competitive levels, and there is a need for improved prevention and early detection. The increasing availability of advanced pitch-tracking data allows for granular evaluation of pitching changes that may precede UCL injury, offering a potential path for early detection. Therefore, the primary objective of this study is to identify predictive pitch-tracking trends of UCL injuries in the season prior to injury, over the offseason, and immediately prior to injury list placement. By analyzing key pitch-tracking metrics including velocity, release extension, release point, and arm angle, within a tightly controlled case-control framework over these specific timeframes, this investigation seeks to identify short-term trends that may serve as early indicators of impending or partial UCL injury. This could ultimately inspire the development of protocols to help prevent UCL injuries or further propagation of a partial tear, potentially making UCL repair an option over reconstruction for a particular patient. Methods: MLB pitchers who met inclusion criteria and underwent UCL surgery from 2021-2025 were identified, resulting in 78 cases which were matched 2:1 with controls (n = 156) by season, age, handedness, and workload. Fastball metrics were evaluated in three stages: (1) baseline differences in mean values and intra-outing variability during the full pre-injury season; (2) within-pitcher changes across three defined intervals- late vs early pre-injury season (ΔS1), early injury season vs late pre-injury season (ΔOffseason), and immediately pre-injury vs early injury season (ΔS2); and (3) linear trends over the final five outings before IL placement. Mixed-effects models and paired comparisons assessed differences in mean values and intra-outing variability for six mechanical variables. Results: Injured pitchers showed greater variability in velocity ( p = 0.012) and horizontal release position ( p = 0.005) at baseline. A medial shift in release point was observed during ΔS1 ( p < 0.001), followed by a lateral shift during ΔOffseason ( p = 0.004). Extension variability increased in ΔS1 ( p = 0.038) and significantly decreased across the offseason ( p = 0.007). Spin rate rose significantly in ΔS2 ( p = 0.019). Injured pitchers also demonstrated progressive velocity decline across their final five outings ( p = 0.019); controls remained stable. Conclusions: This study identified distinct patterns of short-term change in fastball pitch-tracking metrics among MLB pitchers in the months immediately preceding UCL surgery. Rather than average values alone, fastball variability in velocity, release extension, and horizontal release were identified as risk factors for UCL injury, highlighting the importance of repeatable pitching mechanics. These changes emerged at multiple timepoints, beginning in the pre-injury season, reappearing after the offseason, and often intensifying shortly before removal from competition, while controls remained comparatively stable. Importantly, alterations in velocity and spin rate may act as early warning signs for UCL injury.

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