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. 2025 Jul 7;13(7):23259671251352199.
doi: 10.1177/23259671251352199. eCollection 2025 Jul.

Epidemiology of Elbow Medial Ulnar Collateral Ligament Surgeries in Major and Minor League Baseball Pitchers: A Descriptive Study of 2281 Cases

Fabien Meta  1 , Keith Meister  2 , Timothy B Griffith  3 , Stan Conte  4 , Peter N Chalmers  5 , Sophia Mavrommatis  1 , Sean C Clark  1 , Elizabeth Hebert  6 , Christopher L Camp  1
Affiliations

Epidemiology of Elbow Medial Ulnar Collateral Ligament Surgeries in Major and Minor League Baseball Pitchers: A Descriptive Study of 2281 Cases

Fabien Meta et al. Orthop J Sports Med. .

Abstract

Background: Injuries of the medial ulnar collateral ligament (MUCL) among baseball pitchers are increasing. Surgical treatment is evolving to optimize outcomes.

Purpose/hypothesis: This study's purpose was to highlight trends in MUCL repair and reconstruction in professional pitchers, describe outcomes such as return to any level of play (RTP), and identify factors impacting these outcomes. It was hypothesized that primary and revision MUCL surgery is increasing, with revision surgery requiring greater RTP time.

Study design: Case series; Level of evidence, 4.

Methods: The Major League Baseball (MLB) Health and Injury Tracking System database was used to procure data during the study period (2010-2023). All professional pitchers who underwent MUCL surgery during this period were included. RTP was defined as a pitcher returning to at least 1 professional game after index surgery. Return to the same level of play (RTSL) was defined as return to at least 1 game in the same league of play as before surgery. Because of the coronavirus pandemic, the year 2020 was considered an outlier and omitted from time-trend analysis.

Results: A total of 2281 pitchers who underwent MUCL surgery during the study period were included for analysis. The number of MUCL surgeries for pitchers increased yearly (R 2 = 0.821; P < .001), as did the number of reconstructions with internal brace augmentation (R 2 = 0.896; P < .001). The RTP rate for MLB pitchers was significantly higher than the RTSL rate (93% vs 71%; P < .001). This difference was not observed in Minor League Baseball (MiLB) pitchers (RTP 76% vs RTSL 74%; P = .142). RTP rates after revision surgery were lower than those after primary surgery (71% vs 80%; P = .020). The mean time to RTP was shorter (470 ± 135 days) than the mean time to RTSL (499 ± 153 days; P < .001).

Conclusion: The incidence of MUCL surgery and revision surgery is increasing among professional pitchers. Overall, 79% of pitchers returned to any level of play at a mean of 470 days, while 74% returned to the same level of play at a mean of 499 days, but this varied based on level of play. This study will guide athlete expectations and surgeon decision-making.

Keywords: MUCL reconstruction; MUCL repair; baseball; pitchers.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: T.B.G. has received travel and lodging and food and beverage from United Orthopedics LLC. P.N.C. has received consulting fees from DePuy Synthes Products, Exactech, Medical Device Business Services, and Smith & Nephew. C.L.C. has received travel and lodging, food and beverage, and nonconsulting fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
The annual number of medial ulnar collateral ligament surgeries performed on Major and Minor League Baseball pitchers from 2010 to 2023 (R2 = 0.821; P < .001).
Figure 2.
Figure 2.
The annual percentage of medial ulnar collateral ligament surgeries performed on Minor League Baseball pitchers relative to all baseball pitchers from 2010 to 2023 (R2 = 0.539; P = .004).
Figure 3.
Figure 3.
Percentage of Major League Baseball (MLB) and Minor League Baseball (MiLB) pitchers able to return to professional play at any level and their prior level of performance. *Statistically significant difference (P < .05).
Figure 4.
Figure 4.
Mean time (days) for Major League Baseball (MLB) and Minor League Baseball (MiLB) pitchers to return to professional play at any level and their prior level of performance. *Statistically significant difference (P < .05).
Figure 5.
Figure 5.
Percentage of revision medial ulnar collateral ligament surgeries performed each year in Major and Minor League Baseball pitchers, as a proportion of all medial ulnar collateral ligament surgeries (R2 = 0.322; P = .043).
See this image and copyright information in PMC

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