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Upper-Extremity Injuries Have the Poorest Return to Play and Most Time Lost in Professional Baseball: A Systematic Review of Injuries in Major League Baseball

Published:December 28, 2022DOI:https://doi.org/10.1016/j.arthro.2022.12.024

      Purpose

      To summarize the incidence of injuries occurring in professional baseball and compare player outcomes reported in the literature.

      Methods

      We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across 3 databases (PubMed, MEDLINE, Embase). Inclusion criteria were studies of injury incidences and/or injury outcomes on active Major League Baseball (MLB) athletes and studies published in the English language. Exclusion criteria were non-MLB players, case series and case report studies with a cohort of ≤3 players, and/or review articles.

      Results

      A total of 477 articles were identified from the initial search of 3 databases, with 105 studies meeting inclusion criteria. Among these articles, the most common injuries studied were elbow (38%), shoulder (14%), hip/groin (11%), hand/wrist (7%), head/face (7%), knee (7%), spine (5%), and foot/ankle (3%). Injuries with the greatest incidence included hand/wrist (150.3 per year), hamstring (7.8-73.5 per year), ulnar collateral ligament (UCL) tears (0.23-26.8 per year), gastrocnemius strains (24.2 per year), and concussions (3.6-20.5 per year). Lowest rates of return to play were seen following shoulder labral tears (40%-72.5%), rotator cuff tears (33.3%-87%), and UCL tears (51%-87.9%). The injuries leading to most time away from sport included elbow UCL tears (average 90.3 days treated nonoperatively to 622.8 days following revision reconstruction), shoulder labral tears (average 315-492 days), and anterior cruciate ligament (ACL) tears (average 156.2-417.5 days). Following ACL tears, rotator cuff tears, shoulder labral tears, and hip femoroacetabular impingement requiring arthroscopy, athletes had a significantly lower workloads compared with before injury upon return to play.

      Conclusions

      Most published investigations focus on elbow injuries of the UCL, with variable return to play and mixed performance following surgery. UCL tears, shoulder labral tears, and ACL tears result in the most missed time. Upper-extremity injury such as shoulder labral tears, rotator cuff tears, and UCL tears had the poorest return to play rates. Workload was most affected following ACL reconstruction, rotator cuff repair, shoulder labral repair, and hip arthroscopy for femoroacetabular impingement.

      Level of Evidence

      IV, systematic review of level II-IV studies.
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      References

        • Posner M.
        • Cameron K.L.
        • Wolf J.M.
        • Belmont Jr., P.J.
        • Owens B.D.
        Epidemiology of Major League Baseball injuries.
        Am J Sports Med. 2011; 39: 1676-1680
        • Werner S.L.
        • Gill T.J.
        • Murray T.A.
        • Cook T.D.
        • Hawkins R.J.
        Relationships between throwing mechanics and shoulder distraction in professional baseball pitchers.
        Am J Sports Med. 2001; 29: 354-358
        • Fleisig G.S.
        • Andrews J.R.
        • Dillman C.J.
        • Escamilla R.F.
        Kinetics of baseball pitching with implications about injury mechanisms.
        Am J Sports Med. 1995; 23: 233-239
        • Escamilla R.F.
        • Fleisig G.S.
        • Groeschner D.
        • Akizuki K.
        Biomechanical comparisons among fastball, slider, curveball, and changeup pitch types and between balls and strikes in professional baseball pitchers.
        Am J Sports Med. 2017; 45: 3358-3367
        • Conte S.
        • Camp C.L.
        • Dines J.S.
        Injury Trends in Major League Baseball over 18 seasons: 1998-2015.
        Am J Orthop (Belle Mead NJ). 2016; 45: 116-123
        • Camp C.L.
        • Dines J.S.
        • van der List J.P.
        • et al.
        Summative report on time out of play for major and minor league baseball: An analysis of 49,955 injuries from 2011 through 2016.
        Am J Sports Med. 2018; 46: 1727-1732
        • Swindell H.W.
        • Coury J.R.
        • Dantzker N.
        • et al.
        A systematic review of the orthopaedic literature on truncal and lower extremity injuries in Major League Baseball players.
        J Am Acad Orthop Surg Glob Res Rev. 2021; 5
        • Meldau J.E.
        • Srivastava K.
        • Okoroha K.R.
        • Ahmad C.S.
        • Moutzouros V.
        • Makhni E.C.
        Cost analysis of Tommy John surgery for Major League Baseball teams.
        J Shoulder Elbow Surg. 2020; 29: 121-125
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Green G.
        • Pollack Porter K.M.
        • Kvit A.
        • et al.
        Examining batting performance after a sports-related concussion among Major League Baseball position players.
        Am J Sports Med. 2021; 49: 790-797
        • Peterson J.G.
        • Tjong V.K.
        • Terry M.A.
        • Saltzman M.D.
        • Gryzlo S.M.
        • Sheth U.
        Concussion incidence and impact on player performance in Major League Baseball players before and after a standardized concussion protocol.
        Orthop J Sports Med. 2020; 82325967120913020
        • Athiviraham A.
        • Bartsch A.
        • Mageswaran P.
        • et al.
        Analysis of baseball-to-helmet impacts in Major League Baseball.
        Am J Sports Med. 2012; 40: 2808-2814
        • Green G.A.
        • Pollack K.M.
        • D'Angelo J.
        • et al.
        Mild traumatic brain injury in major and Minor League Baseball players.
        Am J Sports Med. 2015; 43: 1118-1126
        • Ramkumar P.N.
        • Navarro S.M.
        • Haeberle H.S.
        • et al.
        Short-term outcomes of concussions in Major League Baseball: A historical cohort study of return to play, performance, longevity, and financial impact.
        Orthop J Sports Med. 2018; 62325967118814238
        • Sabesan V.J.
        • Prey B.
        • Smith R.
        • Lombardo D.J.
        • Borroto W.J.
        • Whaley J.D.
        Concussion rates and effects on player performance in Major League Baseball players.
        Open Access J Sports Med. 2018; 9: 253-260
        • Wasserman E.B.
        • Abar B.
        • Shah M.N.
        • Wasserman D.
        • Bazarian J.J.
        Concussions are associated with decreased batting performance among Major League Baseball players.
        Am J Sports Med. 2015; 43: 1127-1133
        • Wu B.W.
        • Jazayeri H.E.
        • Lee K.C.
        • Khavanin N.
        • Dorafshar A.H.
        • Peacock Z.S.
        Characterizing craniomaxillofacial injuries in American professional sports leagues.
        J Oral Maxillofac Surg. 2020; 78: 588-593
        • Mai H.T.
        • Chun D.S.
        • Schneider A.D.
        • Hecht A.C.
        • Maroon J.C.
        • Hsu W.K.
        The difference in clinical outcomes after anterior cervical fusion, disk replacement, and foraminotomy in professional athletes.
        Clin Spine Surg. 2018; 31: E80-E84
        • Watkins RGt
        • Chang D.
        • Watkins 3rd, R.G.
        Return to play after anterior cervical discectomy and fusion in professional athletes.
        Orthop J Sports Med. 2018; 62325967118779672
        • Earhart J.S.
        • Roberts D.
        • Roc G.
        • Gryzlo S.
        • Hsu W.
        Effects of lumbar disk herniation on the careers of professional baseball players.
        Orthopedics. 2012; 35: 43-49
        • Hsu W.K.
        • McCarthy K.J.
        • Savage J.W.
        • et al.
        The Professional Athlete Spine Initiative: Outcomes after lumbar disc herniation in 342 elite professional athletes.
        Spine J. 2011; 11: 180-186
        • Gould H.P.
        • Winkelman R.D.
        • Tanenbaum J.E.
        • et al.
        Epidemiology, treatment, and performance-based outcomes in American professional baseball players with symptomatic spondylolysis and isthmic spondylolisthesis.
        Am J Sports Med. 2020; 48: 2765-2773
        • Gutman M.J.
        • Gutman B.S.
        • Joyce C.D.
        • Kirsch J.M.
        • Sherman M.B.
        • Namdari S.
        Performance in Major League Baseball pitchers after surgical treatment of thoracic outlet syndrome.
        Phys Sportsmed. 2021; : 1-6
        • Thompson R.W.
        • Dawkins C.
        • Vemuri C.
        • Mulholland M.W.
        • Hadzinsky T.D.
        • Pearl G.J.
        Performance metrics in professional baseball pitchers before and after surgical treatment for neurogenic thoracic outlet syndrome.
        Ann Vasc Surg. 2017; 39: 216-227
        • Frantz T.
        • Ramkumar P.N.
        • Frangiamore S.
        • et al.
        Epidemiology of acromioclavicular joint injuries in professional baseball: Analysis from the Major League Baseball Health and Injury Tracking System.
        J Shoulder Elbow Surg. 2021; 30: 127-133
        • Higgins M.J.
        • DeFroda S.
        • Yang D.S.
        • Brown S.M.
        • Mulcahey M.K.
        Professional athlete return to play and performance after shoulder arthroscopy varies by sport.
        Arthrosc Sports Med Rehabil. 2021; 3: e391-e397
        • Ahmad C.S.
        • Dick R.W.
        • Snell E.
        • et al.
        Major and Minor League Baseball hamstring injuries: Epidemiologic findings from the Major League Baseball Injury Surveillance System.
        Am J Sports Med. 2014; 42: 1464-1470
        • Chalmers P.N.
        • Erickson B.J.
        • D'Angelo J.
        • Ma K.
        • Romeo A.A.
        Epidemiology of shoulder surgery among professional baseball players.
        Am J Sports Med. 2019; 47: 1068-1073
        • Erickson B.J.
        • Chalmers P.N.
        • D'Angelo J.
        • Ma K.
        • Romeo A.A.
        Performance and return to sport after latissimus dorsi and teres major tears among professional baseball pitchers.
        Am J Sports Med. 2019; 47: 1090-1095
        • Gulotta L.V.
        • Lobatto D.
        • Delos D.
        • Coleman S.H.
        • Altchek D.W.
        Anterior shoulder capsular tears in professional baseball players.
        J Shoulder Elbow Surg. 2014; 23: e173-e178
        • Makhni E.C.
        • Lee R.W.
        • Nwosu E.O.
        • Steinhaus M.E.
        • Ahmad C.S.
        Return to competition, re-injury, and impact on performance of preseason shoulder injuries in Major League Baseball pitchers.
        Phys Sportsmed. 2015; 43: 300-306
        • Cerynik D.L.
        • Ewald T.J.
        • Sastry A.
        • Amin N.H.
        • Liao J.G.
        • Tom J.A.
        Outcomes of isolated glenoid labral injuries in professional baseball pitchers.
        Clin J Sport Med. 2008; 18: 255-258
        • Chalmers P.N.
        • Erickson B.J.
        • Verma N.N.
        • D'Angelo J.
        • Romeo A.A.
        Incidence and return to play after biceps tenodesis in professional baseball players.
        Arthroscopy. 2018; 34: 747-751
        • Fedoriw W.W.
        • Ramkumar P.
        • McCulloch P.C.
        • Lintner D.M.
        Return to play after treatment of superior labral tears in professional baseball players.
        Am J Sports Med. 2014; 42: 1155-1160
        • Ricchetti E.T.
        • Weidner Z.
        • Lawrence J.T.
        • Sennett B.J.
        • Huffman G.R.
        Glenoid labral repair in Major League Baseball pitchers.
        Int J Sports Med. 2010; 31: 265-270
        • Smith R.
        • Lombardo D.J.
        • Petersen-Fitts G.R.
        • et al.
        Return to play and prior performance in Major League Baseball pitchers after repair of superior labral anterior-posterior tears.
        Orthop J Sports Med. 2016; 42325967116675822
        • Dines J.S.
        • Jones K.
        • Maher P.
        • Altchek D.
        Arthroscopic management of full-thickness rotator cuff tears in Major League Baseball Pitchers: The lateralized footprint repair technique.
        Am J Orthop (Belle Mead NJ). 2016; 45: 128-133
        • Erickson B.J.
        • Chalmers P.N.
        • D'Angelo J.
        • Ma K.
        • Romeo A.A.
        Performance and return to sport following rotator cuff surgery in professional baseball players.
        J Shoulder Elbow Surg. 2019; 28: 2326-2333
        • Mazoue C.G.
        • Andrews J.R.
        Repair of full-thickness rotator cuff tears in professional baseball players.
        Am J Sports Med. 2006; 34: 182-189
        • Reynolds S.B.
        • Dugas J.R.
        • Cain E.L.
        • McMichael C.S.
        • Andrews J.R.
        Débridement of small partial-thickness rotator cuff tears in elite overhead throwers.
        Clin Orthop Relat Res. 2008; 466: 614-621
        • Erickson B.J.
        • Chalmers P.N.
        • D'Angelo J.
        • Ma K.
        • Ahmad C.S.
        • Romeo A.A.
        Performance and return to sport after open reduction and internal fixation of the olecranon in professional baseball players.
        Am J Sports Med. 2019; 47: 1915-1920
        • Erickson B.J.
        • Chalmers P.N.
        • D'Angelo J.
        • Ma K.
        • Romeo A.A.
        Performance and return to sport after ulnar nerve decompression/transposition among professional baseball players.
        Am J Sports Med. 2019; 47: 1124-1129
        • Ciccotti M.G.
        • Pollack K.M.
        • Ciccotti M.C.
        • et al.
        Elbow injuries in professional baseball: Epidemiological findings from the Major League Baseball Injury Surveillance System.
        Am J Sports Med. 2017; 45: 2319-2328
        • Begly J.P.
        • Guss M.S.
        • Wolfson T.S.
        • Mahure S.A.
        • Rokito A.S.
        • Jazrawi L.M.
        Performance outcomes after medial ulnar collateral ligament reconstruction in Major League Baseball positional players.
        J Shoulder Elbow Surg. 2018; 27: 282-290
        • Chauhan A.
        • McQueen P.
        • Chalmers P.N.
        • et al.
        Nonoperative treatment of elbow ulnar collateral ligament injuries with and without platelet-rich plasma in professional baseball players: A comparative and matched cohort analysis.
        Am J Sports Med. 2019; 47: 3107-3119
        • Erickson B.J.
        • Chalmers P.N.
        • D'Angelo J.
        • Ma K.
        • Dines J.S.
        • Romeo A.A.
        Do outcomes or subsequent injuries differ after ulnar collateral ligament reconstruction with palmaris versus hamstring autograft?.
        Am J Sports Med. 2019; 47: 1473-1479
        • Griffith T.B.
        • Ahmad C.S.
        • Gorroochurn P.
        • et al.
        Comparison of outcomes based on graft type and tunnel configuration for primary ulnar collateral ligament reconstruction in professional baseball pitchers.
        Am J Sports Med. 2019; 47: 1103-1110
        • Marshall N.E.
        • Keller R.A.
        • Limpisvasti O.
        • ElAttrache N.S.
        Pitching performance after ulnar collateral ligament reconstruction at a single institution in Major League Baseball Pitchers.
        Am J Sports Med. 2018; 46: 3245-3253
        • McKnight B.
        • Heckmann N.D.
        • Chen X.T.
        • et al.
        Effect of ulnar collateral ligament reconstruction on pitch accuracy, velocity, and movement in Major League Baseball pitchers.
        Orthop J Sports Med. 2020; 82325967120968530
        • Selley R.S.
        • Portney D.A.
        • Lawton C.D.
        • et al.
        Advanced baseball metrics indicate significant decline in MLB pitcher value after Tommy John surgery.
        Orthopedics. 2019; 42: 349-354
        • Camp C.L.
        • Conte S.
        • D'Angelo J.
        • Fealy S.A.
        Following ulnar collateral ligament reconstruction, professional baseball position players return to play faster than pitchers, but catchers return less frequently.
        J Shoulder Elbow Surg. 2018; 27: 1078-1085
        • DeFroda S.F.
        • Kriz P.K.
        • Hall A.M.
        • Zurakowski D.
        • Fadale P.D.
        Risk Stratification for ulnar collateral ligament injury in Major League Baseball players: A retrospective study from 2007 to 2014.
        Orthop J Sports Med. 2016; 42325967115627126
        • Erickson B.J.
        • Ahn J.
        • Chalmers P.N.
        • et al.
        Reasons for retirement following ulnar collateral ligament reconstruction among Major League Baseball pitchers.
        Orthop J Sports Med. 2017; 52325967117745021
        • Erickson B.J.
        • Chalmers P.N.
        • Bach Jr., B.R.
        • et al.
        Length of time between surgery and return to sport after ulnar collateral ligament reconstruction in Major League Baseball pitchers does not predict need for revision surgery.
        J Shoulder Elbow Surg. 2017; 26: 699-703
        • Erickson B.J.
        • Cvetanovich G.L.
        • Bach Jr., B.R.
        • Bush-Joseph C.A.
        • Verma N.N.
        • Romeo A.A.
        Should we limit innings pitched after ulnar collateral ligament reconstruction in Major League Baseball pitchers?.
        Am J Sports Med. 2016; 44: 2210-2213
        • Jack 2nd, R.A.
        • Burn M.B.
        • Sochacki K.R.
        • McCulloch P.C.
        • Lintner D.M.
        • Harris J.D.
        Performance and return to sport after Tommy John surgery among Major League Baseball position players.
        Am J Sports Med. 2018; 46: 1720-1726
        • Keller R.A.
        • Mehran N.
        • Khalil L.S.
        • Ahmad C.S.
        • ElAttrache N.
        Relative individual workload changes may be a risk factor for rerupture of ulnar collateral ligament reconstruction.
        J Shoulder Elbow Surg. 2017; 26: 369-375
        • Keller R.A.
        • Mehran N.
        • Marshall N.E.
        • et al.
        Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.
        J Shoulder Elbow Surg. 2017; 26: 288-294
        • Marshall N.E.
        • Jildeh T.R.
        • Okoroha K.R.
        • et al.
        Performance, return to play, and career longevity after ulnar collateral ligament reconstruction in professional catchers.
        Arthroscopy. 2018; 34: 1809-1815
        • Peterson E.E.
        • Handwork P.
        • Soloff L.
        • Schickendantz M.S.
        • Frangiamore S.J.
        Effects of ulnar collateral ligament reconstruction on pitch selection in Major League Baseball pitchers.
        Orthop J Sports Med. 2018; 62325967118810003
        • Erickson B.J.
        • Gupta A.K.
        • Harris J.D.
        • et al.
        Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers.
        Am J Sports Med. 2014; 42: 536-543
        • Jiang J.J.
        • Leland J.M.
        Analysis of pitching velocity in major league baseball players before and after ulnar collateral ligament reconstruction.
        Am J Sports Med. 2014; 42: 880-885
        • Keller R.A.
        • Marshall N.E.
        • Guest J.M.
        • Okoroha K.R.
        • Jung E.K.
        • Moutzouros V.
        Major League Baseball pitch velocity and pitch type associated with risk of ulnar collateral ligament injury.
        J Shoulder Elbow Surg. 2016; 25: 671-675
        • Keller R.A.
        • Steffes M.J.
        • Zhuo D.
        • Bey M.J.
        • Moutzouros V.
        The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.
        J Shoulder Elbow Surg. 2014; 23: 1591-1598
        • Lansdown D.A.
        • Feeley B.T.
        The effect of ulnar collateral ligament reconstruction on pitch velocity in Major League Baseball pitchers.
        Orthop J Sports Med. 2014; 22325967114522592
        • Prodromo J.
        • Patel N.
        • Kumar N.
        • Denehy K.
        • Tabb L.P.
        • Tom J.
        Pitch characteristics before ulnar collateral ligament reconstruction in Major League Pitchers compared with age-matched controls.
        Orthop J Sports Med. 2016; 42325967116653946
        • Wilson A.T.
        • Pidgeon T.S.
        • Morrell N.T.
        • DaSilva M.F.
        Trends in revision elbow ulnar collateral ligament reconstruction in professional baseball pitchers.
        J Hand Surg Am. 2015; 40: 2249-2254
        • Wymore L.
        • Chin P.
        • Geary C.
        • et al.
        Performance and injury characteristics of pitchers entering the Major League Baseball draft after ulnar collateral ligament reconstruction.
        Am J Sports Med. 2016; 44: 3165-3170
        • Dugas J.R.
        • Bilotta J.
        • Watts C.D.
        • et al.
        Ulnar collateral ligament reconstruction with gracilis tendon in athletes with intraligamentous bony excision: Technique and results.
        Am J Sports Med. 2012; 40: 1578-1582
        • Gibson B.W.
        • Webner D.
        • Huffman G.R.
        • Sennett B.J.
        Ulnar collateral ligament reconstruction in major league baseball pitchers.
        Am J Sports Med. 2007; 35: 575-581
        • Makhni E.C.
        • Lee R.W.
        • Morrow Z.S.
        • Gualtieri A.P.
        • Gorroochurn P.
        • Ahmad C.S.
        Performance, return to competition, and reinjury after Tommy John surgery in Major League Baseball pitchers: A review of 147 cases.
        Am J Sports Med. 2014; 42: 1323-1332
        • Osbahr D.C.
        • Cain Jr., E.L.
        • Raines B.T.
        • Fortenbaugh D.
        • Dugas J.R.
        • Andrews J.R.
        Long-term outcomes after ulnar collateral ligament reconstruction in competitive baseball players: Minimum 10-year follow-up.
        Am J Sports Med. 2014; 42: 1333-1342
        • Marshall N.E.
        • Keller R.
        • Limpisvasti O.
        • Schulz B.
        • ElAttrache N.
        Major League Baseball pitching performance after Tommy John surgery and the effect of tear characteristics, technique, and graft type.
        Am J Sports Med. 2019; 47: 713-720
        • Erickson B.J.
        • Chalmers P.N.
        • D'Angelo J.
        • et al.
        Side of hamstring harvest does not affect performance, return-to-sport rate, or future hamstring injuries after ulnar collateral ligament reconstruction among professional baseball pitchers.
        Am J Sports Med. 2019; 47: 1111-1116
        • Camp C.L.
        • Desai V.
        • Conte S.
        • et al.
        Revision Ulnar collateral ligament reconstruction in professional baseball: Current trends, surgical techniques, and outcomes.
        Orthop J Sports Med. 2019; 72325967119864104
        • Erickson B.J.
        • Chalmers P.N.
        • D'Angelo J.
        • Ma K.
        • Romeo A.A.
        Open reduction internal fixation of medial epicondyle fractures after ulnar collateral ligament reconstruction in professional baseball pitchers.
        Orthop J Sports Med. 2019; 72325967119852896
        • Liu J.N.
        • Garcia G.H.
        • Conte S.
        • ElAttrache N.
        • Altchek D.W.
        • Dines J.S.
        Outcomes in revision Tommy John surgery in Major League Baseball pitchers.
        J Shoulder Elbow Surg. 2016; 25: 90-97
        • Jones K.J.
        • Conte S.
        • Patterson N.
        • ElAttrache N.S.
        • Dines J.S.
        Functional outcomes following revision ulnar collateral ligament reconstruction in Major League Baseball pitchers.
        J Shoulder Elbow Surg. 2013; 22: 642-646
        • Marshall N.E.
        • Keller R.A.
        • Lynch J.R.
        • Bey M.J.
        • Moutzouros V.
        Pitching performance and longevity after revision ulnar collateral ligament reconstruction in Major League Baseball pitchers.
        Am J Sports Med. 2015; 43: 1051-1056
        • Hodgins J.L.
        • Trofa D.P.
        • Donohue S.
        • Littlefield M.
        • Schuk M.
        • Ahmad C.S.
        Forearm flexor injuries among Major League Baseball players: Epidemiology, performance, and associated injuries.
        Am J Sports Med. 2018; 46: 2154-2160
        • Burleson A.
        • Shin S.
        Return to play after hook of hamate excision in baseball players.
        Orthop J Sports Med. 2018; 62325967118803090
        • Erickson B.J.
        • McElheny K.
        • Chalmers P.N.
        • et al.
        Performance and return to sport after excision of the fractured hook of the hamate in professional baseball players.
        Am J Sports Med. 2020; 48: 3066-3071
        • Guss M.S.
        • Begly J.P.
        • Ramme A.J.
        • Taormina D.P.
        • Rettig M.E.
        • Capo J.T.
        Performance outcomes after hook of hamate fractures in Major League Baseball players.
        J Sport Rehabil. 2018; 27: 577-580
        • Jack 2nd, R.A.
        • Sochacki K.R.
        • Gagliano B.
        • Lintner D.M.
        • Harris J.D.
        • McCulloch P.C.
        Performance and return to sport after thumb ulnar collateral ligament repair in Major League Baseball players.
        Orthop J Sports Med. 2018; 62325967117747268
        • Rhee P.C.
        • Camp C.L.
        • D'Angelo J.
        • et al.
        Epidemiology and impact of hand and wrist injuries in Major and Minor League Baseball.
        Hand (N Y). 2021; 16: 498-504
        • Sheridan J.
        • Sheridan D.
        • Sheridan D.
        Hook of hamate fractures in Major and Minor League Baseball players.
        J Hand Surg Am. 2021; 46: 653-659
        • Ramamurti P.S.
        • Stake S.
        • Fassihi S.C.
        • Pandarinath R.
        • Doerre T.
        No change in performance metrics in Major League Baseball players sustaining wrist fractures after being struck by an errant pitch.
        J Orthop. 2020; 22: 213-219
        • Marshall N.E.
        • Jildeh T.R.
        • Okoroha K.R.
        • Patel A.
        • Moutzouros V.
        • Makhni E.C.
        Implications of core and hip injuries on Major League Baseball pitchers on the disabled list.
        Arthroscopy. 2018; 34: 473-478
        • Byrd J.W.
        • Jones K.S.
        Hip arthroscopy in high-level baseball players.
        Arthroscopy. 2015; 31: 1507-1510
        • Christian R.A.
        • Lubbe R.J.
        • Chun D.S.
        • Selley R.S.
        • Terry M.A.
        • Hsu W.K.
        Prognosis following hip arthroscopy varies in professional athletes based on sport.
        Arthroscopy. 2019; 35 (e831): 837-842
        • Frangiamore S.J.
        • Mannava S.
        • Briggs K.K.
        • McNamara S.
        • Philippon M.J.
        Career length and performance among professional baseball players returning to play after hip arthroscopy.
        Am J Sports Med. 2018; 46: 2588-2593
        • Jack R.A.
        • Sochacki K.R.
        • Hirase T.
        • et al.
        Performance and return to sport after hip arthroscopic surgery in Major League Baseball players.
        Orthop J Sports Med. 2019; 72325967119825835
        • Jack 2nd, R.A.
        • Sochacki K.R.
        • Hirase T.
        • Vickery J.W.
        • Harris J.D.
        Performance and return to sport after hip arthroscopy for femoroacetabular impingement in professional athletes differs between sports.
        Arthroscopy. 2019; 35: 1422-1428
        • Schallmo M.S.
        • Fitzpatrick T.H.
        • Yancey H.B.
        • Marquez-Lara A.
        • Luo T.D.
        • Stubbs A.J.
        Return-to-play and performance outcomes of professional athletes in North America after hip arthroscopy from 1999 to 2016.
        Am J Sports Med. 2018; 46: 1959-1969
        • Coleman S.H.
        • Mayer S.W.
        • Tyson J.J.
        • Pollack K.M.
        • Curriero F.C.
        The epidemiology of hip and groin injuries in professional baseball players.
        Am J Orthop (Belle Mead NJ). 2016; 45: 168-175
        • Howard D.R.
        • Banffy M.B.
        • ElAttrache N.S.
        Hamstring injuries in Major League Baseball pitchers: Implications in graft selection for ulnar collateral ligament reconstruction.
        Am J Sports Med. 2019; 47: 444-450
        • Kantrowitz D.E.
        • Trofa D.P.
        • Woode D.R.
        • Ahmad C.S.
        • Lynch T.S.
        Athletic hip injuries in Major League Baseball pitchers associated with ulnar collateral ligament tears.
        Orthop J Sports Med. 2018; 62325967118800704
        • Okoroha K.R.
        • Conte S.
        • Makhni E.C.
        • et al.
        Hamstring injury trends in Major and Minor League Baseball: Epidemiological findings from the Major League Baseball Health and Injury Tracking System.
        Orthop J Sports Med. 2019; 72325967119861064
        • Schallmo M.S.
        • Singh S.K.
        • Barth K.A.
        • Freshman R.D.
        • Mai H.T.
        • Hsu W.K.
        A cross-sport comparison of performance-based outcomes of professional athletes following primary microfracture of the knee.
        Knee. 2018; 25: 692-698
        • Allahabadi S.
        • Rubenstein W.J.
        • Lansdown D.A.
        • Feeley B.T.
        • Pandya N.K.
        Incidence of anterior cruciate ligament graft tears in high-risk populations: An analysis of professional athlete and pediatric populations.
        Knee. 2020; 27: 1378-1384
        • Dahm D.L.
        • Curriero F.C.
        • Camp C.L.
        • et al.
        Epidemiology and impact of knee injuries in Major and Minor League Baseball Players.
        Am J Orthop (Belle Mead NJ). 2016; 45: E54-E62
        • Erickson B.J.
        • Chalmers P.N.
        • D'Angelo J.
        • et al.
        Performance and return to sport after anterior cruciate ligament reconstruction in professional baseball players.
        Orthop J Sports Med. 2019; 72325967119878431
        • Fabricant P.D.
        • Chin C.S.
        • Conte S.
        • Coleman S.H.
        • Pearle A.D.
        • Dines J.S.
        Return to play after anterior cruciate ligament reconstruction in Major League Baseball athletes.
        Arthroscopy. 2015; 31: 896-900
        • Mai H.T.
        • Chun D.S.
        • Schneider A.D.
        • et al.
        Performance-based outcomes after anterior cruciate ligament reconstruction in professional athletes differ between sports.
        Am J Sports Med. 2017; 45: 2226-2232
        • Nguyen M.T.
        • Hsu W.K.
        Performance-based outcomes following patellar tendon repair in professional athletes.
        Phys Sportsmed. 2020; 48: 110-115
        • Hultman K.
        • Szukics P.F.
        • Grzenda A.
        • Curriero F.C.
        • Cohen S.B.
        Gastrocnemius Injuries in professional baseball players: An epidemiological study.
        Am J Sports Med. 2020; 48: 2489-2498
        • Saltzman B.M.
        • Tetreault M.W.
        • Bohl D.D.
        • Tetreault D.
        • Lee S.
        • Bach Jr., B.R.
        Analysis of Player statistics in Major League Baseball players before and after Achilles tendon repair.
        HSS J. 2017; 13: 108-118
        • Trofa D.P.
        • Miller J.C.
        • Jang E.S.
        • Woode D.R.
        • Greisberg J.K.
        • Vosseller J.T.
        Professional athletes' return to play and performance after operative repair of an Achilles tendon rupture.
        Am J Sports Med. 2017; 45: 2864-2871
        • Singh S.K.
        • Larkin K.E.
        • Kadakia A.R.
        • Hsu W.K.
        Risk factors for reoperation and performance-based outcomes after operative fixation of foot fractures in the professional athlete: A cross-sport analysis.
        Sports Health. 2018; 10: 70-74
        • Bushnell B.D.
        • Anz A.W.
        • Noonan T.J.
        • Torry M.R.
        • Hawkins R.J.
        Association of maximum pitch velocity and elbow injury in professional baseball pitchers.
        Am J Sports Med. 2010; 38: 728-732
        • Cooper D.E.
        • Conway J.E.
        Distal semitendinosus ruptures in elite-level athletes: Low success rates of nonoperative treatment.
        Am J Sports Med. 2010; 38: 1174-1178
        • Bishop M.
        • Astolfi M.
        • Padegimas E.
        • DeLuca P.
        • Hammoud S.
        Venous thromboembolism within professional American sport leagues.
        Orthop J Sports Med. 2017; 52325967117745530
        • Seroyer S.T.
        • Nho S.J.
        • Bach B.R.
        • Bush-Joseph C.A.
        • Nicholson G.P.
        • Romeo A.A.
        The kinetic chain in overhand pitching: Its potential role for performance enhancement and injury prevention.
        Sports Health. 2010; 2: 135-146
        • Wilk K.E.
        • Macrina L.C.
        • Cain E.L.
        • Dugas J.R.
        • Andrews J.R.
        The recognition and treatment of superior labral (SLAP) lesions in the overhead athlete.
        Int J Sports Phys Ther. 2013; 8: 579-600
        • Walker C.M.
        • Genuario J.W.
        • Houck D.A.
        • Murayama S.
        • Mendez H.
        • Noonan T.J.
        Return-to-play outcomes in professional baseball players after nonoperative treatment of incomplete medial ulnar collateral ligament injuries: A long-term follow-up study.
        Am J Sports Med. 2021; 49: 1137-1144
        • Thomas S.J.
        • Paul R.W.
        • Rosen A.B.
        • et al.
        Return-to-play and competitive outcomes after ulnar collateral ligament reconstruction among baseball players: A systematic review.
        Orthop J Sports Med. 2020; 82325967120966310