Early-career ulnar collateral ligament reconstruction in elite baseball pitchers: impact on professional career performance, longevity, and earning potential

Peter K Kriz; Steven J Staffa; John P Kriz; Mininder S Kocher

doi:10.1016/j.jseint.2025.09.011

Early-career ulnar collateral ligament reconstruction in elite baseball pitchers: impact on professional career performance, longevity, and earning potential

JSES Int. 2025 Oct 15;10(1):101391. doi: 10.1016/j.jseint.2025.09.011. eCollection 2026 Jan.

Authors

Peter K Kriz¹, Steven J Staffa², John P Kriz³, Mininder S Kocher¹

Affiliations

¹ Division of Sports Medicine, Departments of Orthopedics, Boston Children's Hospital, Boston, MA, USA.
² Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
³ Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA.

Abstract

Background: The 15-to-19-year-old age group of baseball pitchers has an annual ulnar collateral ligament reconstruction (UCL-R) surgical incidence that is higher than any other demographic, and recent trends among elite pitchers show steady declines in average age of first UCL-R. There is a paucity of literature evaluating the impact of early-career UCL-R on an elite pitcher's professional career, including performance, career longevity, and career earnings.

Methods: Demographic, high school showcase, professional performance, injury data, and earnings from pitchers selected in the first 5 rounds of the Major League Baseball (MLB) draft (2011-2020) were gathered from publicly available databases. One-way between-groups analysis of variance for continuous variables comparing 3 UCL-R groups (early, middle, and late career) with a control group (no UCL-R) was performed, and multivariable linear regression for outcomes significant upon analysis of variance was conducted. Standard deviations (SDs) of ±1 SD were used to define early, middle, and late career UCL-R subgroups after normal distribution was confirmed (Shapiro-Wilk test, P = .188). The early-career UCL-R group was defined as ≤ -1 SD (19.49 years), while the late-career UCL-R group was defined as ≥ +1 SD (25.67 years).

Results: Of 851 pitchers, 281 (33.0%) had undergone primary UCL-R at manuscript preparation. Compared to early-career UCL-R pitchers, median MLB career earnings (adjusted for inflation) were significantly higher for middle- (P = .047) and late-career UCL-R pitchers (P < .001) following adjustment for confounders including age. UCL-R return to sport recovery time (any level) for primary reconstruction was significantly longer for early-career UCL-R compared to late-career UCL-R pitchers (19.79 ± 5.69 vs. 15.36 ± 3.45 months, P = .023).

Conclusion: Early-career UCL-R may be associated with lower MLB career earnings compared to middle-to-late-career UCL-R surgery in a cohort of high-round MLB draft pitchers. In addition, prolonged recovery time following early-career UCL-R may result in an increased mental health burden that warrants further investigation.

Keywords: Baseball; Elbow; Major league baseball; Pitching; Ulnar collateral ligament reconstruction; Velocity.