Regarding a decline in overall performance and not elbow and shoulder injury being the most prevalent reason for retirement in the UCLR group, Erickson said, “As most MLB players age, their performance declines. Their shoulder and elbow begin to wear out, their back and scapular muscles (latissimus) may begin to hurt, and they oftentimes become less effective.”
“When they start to have more general aches and pains, they can become less effective pitchers. They have not sustained a discrete injury to their shoulder or elbow, but they are just beginning to break down in general. When their performance begins to decline, and they can no longer compete at an elite level, they will often retire.”
Erickson and colleagues also pointed out that while many surgeons believe that prior elbow injury or elbow surgery, including UCLR, are risk factors for sustaining a shoulder injury, no study to date including the current study has shown this to be true.
They suggested that the rigor of rehabilitation process and the improvement in pitching mechanics seen following UCLR may be the reason although more research into this must be done to get any definitive answers.
When it comes to the higher number of leg injuries in the control group than in the UCLR group, Erickson suggested that this may also be due to an improvement in balance and throwing mechanisms after UCLR.
Other Factors May Be in Play
The researchers also found some other interesting contrasts between the UCLR and non-UCLR pitchers. For example, in the UCLR group, more of the players were drafted out of high school compared to the non-UCLR group where most the players were drafted out of college. In addition, performance wise, UCLR pitchers had a better WHIP (walks plus hits per inning pitched) during the peak performance year of their careers and in their last year before retirement compared to those pitchers who never had the surgery.
They wrote, “Furthermore, pitchers who underwent UCLR had a higher season salary than controls. This shows that, according to performance and salary, better pitchers were more likely to undergo UCLR than pitchers who were not as highly valued or as effective (controls). However, at the end of their careers, players who underwent UCLR were more likely than controls to be released during the season. This finding could indicate a rapid in-season decline in performance among these pitchers, as they were not retained through the end of their final seasons, although the etiology of this decline is unknown.”
UCLR’s Effect on Performance
While the results of this study offer good news on the long-term results of UCLR in baseball pitchers, they also bring up questions on how else the surgery might affect performance after the athlete returns to sport.
Erickson said, “We know that some pitchers return at the same or higher level after UCLR, but some do not. There have been some studies that have shown pitchers lose a small amount of velocity on their fastball following UCLR. No studies have really looked at the mental component of returning to sport following UCLR (meaning, do players feel confident in their elbow, or are they worried that they could potentially injure it again and thus favor it slightly).
“There are other issues at play as well when players undergo UCLR. Recent studies have found loss of shoulder rotation can increase players’ risk for a UCL injury. Hence, when players return following UCLR, their pitching coach often focuses on maintaining shoulder ROM [range of motion]. Pitchers may also change their pitching mechanics when they return to put less stress on the elbow.”
He added, “The take home message is that MLB pitchers who have undergone UCLR are no more likely to retire from shoulder or elbow injuries than are those who have not undergone UCLR, and that career length was similar between pitchers with and without a history of UCLR. Hence, UCLR is a successful, albeit not perfect, procedure at returning these elite athletes to their sport and allowing them to continue to compete at a high-level year after their surgery.”
On limitations of the study, Erickson said, “Any study that uses publicly available data is subject to some limitations. The main issue is with verification of what is found on injury reports, team website, etc. As you know, teams do not always know what is exactly wrong with a player at first, or a player may not want to divulge what is wrong, so the information can be difficult to locate and validate.”
Erickson and his colleagues called for further studies to evaluate possible reasons for the decline in performance seen in the UCLR group.
