Effect of COVID-19 on Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

Abstract

Background: The coronavirus disease of 2019 (COVID-19) pandemic led to the suspension and shortening of the 2020 Major League Baseball (MLB) season from 162 to 60 regular season games. The effect of this disruption on injury rates, specifically injury to the ulnar collateral ligament (UCL), has not been quantified. Purpose/Hypothesis: The purpose of this study was to compare the rate of UCL reconstruction (UCLR), surgery timing, and pitching workload in MLB pitchers from before and after the COVID-19 pandemic lockdown. We hypothesized that UCLR rates relative to games played would be increased and pitching workload would be decreased in 2020 compared with previous seasons. Study Design: Cohort study; Level of evidence, 3. Methods: An extensive online search using publicly available data was conducted to identify all MLB pitchers who underwent UCLR between January 1, 2017, and December 31, 2020. Only pitchers who were competing at the MLB level when undergoing reconstruction were included. Player characteristics and surgery date, as well as career and season of surgery pitching workload, were collected for all included pitchers. All data were compared as a pooled sample (2017-2019 vs 2020). Results: A similar number of pitchers underwent UCLR during or after the 2020 regular season (n = 18) compared with the 2017-2019 seasons (n = 16, 20, and 16, respectively). However, after accounting for the decrease in games played during the 2020 regular season, an MLB pitcher was 2.9 times more likely to undergo surgery per game after the COVID-19 lockdown compared with the previous years ( P < .001). MLB pitchers who underwent surgery in 2020 threw fewer preseason innings than did pitchers who underwent surgery between 2017 and 2019 (5.98 vs 9.39; P = .001). Conclusion: MLB pitchers were almost 3 times more likely to undergo UCLR per game after the COVID-19 lockdown. A decreased preseason pitching workload because of the COVID-19 lockdown may have had an effect on per game UCLR rates.

Impact of COVID on Sports Injury Patterns, Changes in Mental Well-Being, and Strategies to Prepare for Future Pandemics in Sport

“…German Professional Bundesglia Soccer League players had a greater than three times higher rate of injury when controlling for games played compared with injury rates prelockdown (27). In professional baseball players, the overall injury incidence rate in the upper extremities and spine/core was nearly twice that in pitchers and fielders during their shortened 2020 season compared with the two prior seasons (39), and pitchers were 2.9 times more likely to undergo ulnar collateral ligament surgery after the lockdown compared with the previous three years (40,41). Retrospective evidence from the NFL showed that the injury rate of players during weeks 1 to 4 of the 2020 to 2021 regular seasons was higher than that of the three prior preseasons and regular seasons (40).…”

Injury Incidence Increases after COVID-19 Infection: A Case Study with a Male Professional Football Team

“…Recently, increased injury rates have been documented following COVID-19 sports suspension in American Major League Baseball [ 21 , 22 ] and the National Football League [ 23 , 24 ]. European reports did not acknowledge the potential complicating factor of the effects of increases in the acute-to-chronic workload ratio (ACWR).…”

Changes in trends of orthopedic services due to the COVID-19 pandemic: A review

“…Hip replacements are generally the most common elective procedure, but elective procedures were halted and therefore most institutions did not perform them. Hip fractures have still been very common during this time[ 4 , 25 , 28 ]; however, the pandemic has increased the mortality and complication rate particularly amongst COVID-positive patients[ 5 , 8 , 11 , 16 , 38 ]. The importance of early treatment and proper rehabilitation was strongly emphasized in order to ensure prompt recovery[ 14 ].…”

“…Paul et al [ 38 ] studied the effect of COVID-19 on ulnar collateral ligament repair (UCLR) in 106 major league baseball (MLB) players. The study observed at all pitchers of the MLB who underwent UCLR repair and found no difference in overall UCLR repair from baseball seasons 2017 through 2020 ( n = 16, 20, 16, and 18).…”