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Int J Sports Med
DOI: 10.1055/a-2767-0077
Orthopedics & Biomechanics

Performance Outcomes after Ulnar Collateral Ligament Tears in Major League Baseball Pitchers

Authors

  • Zaid Elsabbagh 

    1   School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA (Ringgold ID: RIN1500)

  • Ahmed Sulieman

    1   School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA (Ringgold ID: RIN1500)

  • Ysa Le

    1   School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA (Ringgold ID: RIN1500)

  • Saif Salih

    2   Orthopaedic Surgery, Rush University Rush Medical College, Chicago, USA (Ringgold ID: RIN12245)

  • Mattin Moazzam

    2   Orthopaedic Surgery, Rush University Rush Medical College, Chicago, USA (Ringgold ID: RIN12245)

  • Sukrit Suresh

    1   School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA (Ringgold ID: RIN1500)

  • Matthew Best

    1   School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA (Ringgold ID: RIN1500)
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Abstract

We evaluated performance and salary outcomes following ulnar collateral ligament surgery in Major League Baseball pitchers. This retrospective cohort included 277 pitchers who underwent surgery between 2000 and 2024. Among the 267 pitchers with available return-to-play data, 85% returned to professional competition and 35% had a multiyear contract at the time of injury. Performance, measured as league-adjusted changes in earned run average, fielding independent pitching, and walks plus hits per inning pitched, declined significantly after return (earned run average:+1.45, 95% confidence interval: 0.63–2.26, and p=0.01; fielding independent pitching:+0.88, 95% confidence interval: 0.50–1.27, and p<0.01; walks plus hits per inning pitched:+0.26, 95% confidence interval: 0.14–0.37, and p<0.01). In contrast, salary increased by an average of 16.6% after era adjustment. In multivariable models, greater Major League Baseball experience before injury (p=0.03), higher pre-injury wins above replacement (p<0.01), and multiyear contract status (p<0.01) independently predicted higher post-injury salary, while age, handedness, and in-season injury were not significant. Having a multiyear contract was also the only significant predictor of return-to-play (p=0.049). Overall, Major League Baseball pitchers demonstrated significant performance declines despite salary growth, reflecting service-time progression and contractual security rather than immediate post-injury output.

Keywords

Return to play - pitching performance - Tommy John surgery - professional baseball - sports medicine


Publication History

Received: 06 August 2025

Accepted after revision: 05 December 2025

Accepted Manuscript online:
06 December 2025

Article published online:
30 December 2025

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