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.
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