Abstract
Objectives:
High throwing workload and stresses at the shoulder during the throwing motion put baseball players at risk of posterior labral injury, with posterior labral repair required if shoulder pain is not alleviated with non-operative treatment. However, outcomes for professional baseball players after posterior labral repair are currently unclear. A prior study of 18 pitchers and 14 position players found that only 41% of pitchers able to return to sport (RTS) at the same level of play (RTSS) compared to 86% of position players, however this study was limited by sample size and included players across all levels of play. Therefore, the purpose of this study was to report the return to sport (RTS) rate, time until RTS, and performance outcomes in professional baseball pitchers and position players who underwent isolated posterior labral repair.
Methods:
The MLB Health and Injury Tracking System (HITS) database was queried for all major league and minor league baseball players who underwent isolated posterior labral repair from 2011-2022 using the CPT codes 29806 and 29807. Outcomes of interest included RTS rate, time until RTS, and performance outcomes. Performance outcomes for position players included at-bats (ABs), plate appearances (PAs), batting average (AVG), on-base percentage (OBP), slugging percentage (SLG), and on-base plus slugging percentage (OPS). Performance statistics were evaluated every season-year (SY) from 3 seasons before (SY-3) to 3 seasons after surgery (SY+3).
Results:
Overall, 133 professional baseball players comprised of 55 pitchers and 78 position players were included with 118 (88.7%) players at the Minor League Baseball level and a mean age of 23±3 years. Position players were more often right-hand dominant (94.8% vs. 69.1%, p<0.001) and younger (22.1 years vs. 23.0 years, p=0.016) than pitchers. Position players were able to RTS at a higher rate than pitchers (91.0% vs. 74.5%, p=0.020) and were able to RTS sooner (251 days vs. 330 days, p<0.001) than pitchers. Starting pitchers took longer to RTS than relief pitchers (348 days vs. 268 days, p=0.013). Professional pitchers experience a significant decrease in innings pitched and other workload-related counting statistics (hits, base on balls, strikeouts) during the year of injury and the first year after surgery, however these statistics returned near baseline by the second year after surgery (p=0.003). ERA is significantly increased three years post-surgery (SY+3) compared to SY-1, SY-0, SY+1, and SY+2 (p=0.003, p=0.036, p=0.023, p=0.041, respectively), and WHIP is also significantly increased three years post-surgery compared to one year before surgery (p=0.022). In position players, both at-bats (226.3 vs. 111.2, p=0.003) and plate appearances (257.2 vs. 124.2, p=0.002) decreased significantly from the year before surgery to the year of surgery, and then were significantly increased by the third year after surgery (p=0.010 and p=0.009, respectively). Batting average also changed significantly throughout the study timeline (p=0.032), however no specific yearly comparisons found statistical significance.
Conclusions:
Professional baseball pitchers are able to RTS less frequently and take longer RTS than position players after isolated posterior labral repair. Pitchers experience a significant decrease in workload the first season after surgery and worsened rate statistics (ERA, WHIP) three seasons postoperatively.
