Major League Baseball

Team physicians may be called upon to treat adolescent athletes, defined in this document as those in the range of 12-18 yr of age. Many are involved in school-based, intramural, or specialized sports participation and/or training, potentially resulting in injury and/or illness. Specialized treatments may be necessary due to growth and development of the adolescent. Additionally, psychological factors in this age group may play an important role in sports participation, emotional well-being, and injury rehabilitation. While many children younger than 12 yr of age are active in sports participation, their medical and musculoskeletal concerns are not included in the scope of this consensus statement. The healthcare team must stay educated and knowledgeable regarding potential challenges to individuals participating safely in sport. All healthcare professionals should provide quality care, free from discrimination and specific to the needs of every unique individual. Ensuring access to care, fostering welcoming sporting environments, and recognizing the distinct challenges faced by underrepresented populations will reduce healthcare disparities and improve safe participation across all sports.

The aim of this study was to investigate the short-term outcomes of tibial plateau levelling osteotomy (TPLO) and tibial tuberosity transposition (TTT) for the combined treatment of cranial cruciate ligament rupture and medial patellar luxation (MPL) in small-breed dogs weighing up to 15 kg.Retrospective case series of dogs treated with a single session TPLO-TTT from five referral centres between 2015 and 2023. Intraoperative and postoperative complications were assessed. Osteotomy healing, lameness and presence of patellar luxation or tibial thrust were assessed at a 6- to 12-week follow-up.A total of 37 stifles in 35 dogs. At the time of follow-up, the tibial compression test was negative in all stifles. The MPL grade improved from a median of 3/4 preoperatively to a median of 0/4 (p = 0.0001) postoperatively. Lameness grade improved from a median of 3/5 to 1/5. There were seven minor complications and seven major complications. No catastrophic complications occurred. Osteotomy healing was appropriate in all dogs. Three intraoperative complications related to a TPLO screw near the joint required replacement. Postoperative MPL was noted in three stifle joints (grade 1/4, 3/4 and 4/4). One distal tibial tuberosity fracture and one patella fracture were managed conservatively. Patella ligament desmitis was managed conservatively in five stifles.Combined TPLO-TTT is an effective treatment of cranial cruciate ligament rupture and MPL in small-breed dogs, but surgical accuracy is needed to minimize complications. High-grade patellar luxation may require alternative methods of stabilization.

This study examined the running loads of Major League Soccer matches across three seasons. Data was obtained from 1243 individual matches which included 800 players (26 ± 1.1 years) from 28 teams. Data was collected via optical tracking system. All data from players who completed at least 85-minutes of match play were included. Physical performance measures included total distance (m) (TD), high-speed running (19.8–25.2 km ⋅ hr1) (HSR), sprint distance (>25.2 km ⋅ hr1) (SpD), sprint efforts (n) and high-intensity running (>19.8 km ⋅ hr1) (HID). Data was analysed to observe the average match running loads of the measures of physical performance as a whole and within the respective positions, temporal and seasonal. The data was processed using R statistical software. Linear mixed models were used to analyse statistical significance. The average total distance covered was 9950 ± 990m. The average high-speed running 519 ± 171m, whereas the average sprint distance was 166 ± 98. The average sprints (n) were 10 ± 5. CM cover the most total distance (10510 ± 1000m) while full backs and wide midfielders cover the most high-speed running and sprint distance (599 ± 147; 225 ± 98m). Contextual factors such as quality of opposition and venue have an impact on the movement demands of match-play with players covering less TD against higher ranked teams and higher SpD and HID with teams of weaker opposition. However, players performed less TD and SpD when playing away. Furthermore, signifying the importance of understanding a teams’ principles of play and their affect on match running loads.

Background/Objectives: Baseball pitchers accumulate extreme upper extremity forces during the repetitive, high-velocity motion of throwing, which can lead to shoulder dysfunction and overuse injuries. Although scapular dyskinesis has been linked to various shoulder pathologies, there is a lack of evidence on the specific scapular patterns predisposing pitchers to injury. Methods: A total of 85 professional pitchers from a single professional baseball organization participated in the entirety of this study. All subjects had their scapular positions and motion patterns measured via a digital goniometer prior to the beginning of a competitive season. Scapular upward/downward rotation, anterior/posterior tilt, and internal/external rotation were assessed with the shoulder at rest and during elevation to 120° in the scapular plane. Overuse injuries of the shoulder/elbow sustained during the subsequent competitive season were documented by the team’s medical staff, with statistical comparisons between the injured (n = 34) and non-injured (n = 51) group for each scapular measure. Results: Pitchers who sustained shoulder/elbow injuries demonstrated significantly more scapular anterior tilt during humeral elevation compared to those without an injury (p = 0.04). The difference in anterior tilt between the two groups was 3.8° and had a medium effect size, suggesting clinical relevance. No significant between-group differences were found in any other scapular positions or motions (p > 0.22). Conclusions: Pitchers with increased scapular anterior tilt were more likely to sustain a shoulder/elbow injury, highlighting this kinematic feature as a potential risk factor. This finding suggests that anterior tilt might contribute to soft tissue strain, increasing injury susceptibility in pitchers.

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 (R2 = 0.821; P < .001), as did the number of reconstructions with internal brace augmentation (R2 = 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.

A common component within rehabilitation recommendations for baseball pitchers is employment of an interval throwing program. However, there is a lack of a consistent set of advocated guidelines for program content and implementation for athletes at the professional and collegiate levels. Cross-sectional study. A survey was developed to obtain clinician views regarding the composition and implementation of interval throwing programs for baseball pitchers. The survey was divided into demographic information and sections on criteria to begin throwing programs, frequency of throwing, soreness management, warm-up components, program components and regulation of a program, and criteria to achieve permitting live throwing. Clinicians including physicians, physical therapists, and certified athletic trainers who evaluate and treat musculoskeletal injuries among baseball pitchers at the professional-level and/or collegiate-level clinician received the survey. Responses were tabulated and compared between the professional-level clinician and collegiate-level clinician groups using chi-square analyses with statistical significance set at P ≤ .05. The survey was completed by 166 clinicians (collegiate level = 81, professional-level clinician = 85). There were no statistical differences between groups for allowing warm-up throws, program regulation, maximum distance allowed, managing soreness, or criteria to achieve before permitting live throwing. Between-group differences included criteria to begin a program (≤.03), warm-up distance (P ≤ .02), nonthrowing warm-up methods (P ≤ .04), non-warm-up distance (P ≤ .01), using ratings of perceived exertion (P < .01), throwing frequency (P < .01), and program components (P ≤ .04). Responses appear to mirror interval throwing program designs previously reported in the literature but there are modifications and additions utilized by clinicians at different playing levels.

Background: Major League Baseball (MLB) recently instituted a combine for their prospective players. Purpose/Hypothesis: The purpose of this study was to report initial epidemiological findings for both physical examination and imaging findings for the MLB Combine. It was hypothesized that most players would have no significant abnormal physical examination findings, but most would have abnormal findings on their shoulder and elbow magnetic resonance imaging (MRI) scans. Study Design: Descriptive epidemiology study. Methods: All players who attended the 2023 MLB Combine were included. History was taken and physical examination was performed by an MLB team physician, and MRI of the shoulder, elbow, cervical spine, and lumbar spine was performed on all players and read by 1 of 2 musculoskeletal radiologists. Physical examination notes and imaging reports were reviewed by the authors and recorded. Data were analyzed separately for pitchers and position players. Results: Overall, 219 players (112 pitchers [51%], 107 position players [49%]) were included. The mean age was 20.4 ± 1.5 years. The majority of players (95%) had no current pain or limitations; 54 players (25%) had a history of previous surgery. For pitchers, 18% underwent previous elbow surgery. With regard to MRI, >80% of pitchers had some abnormality within their ulnar collateral ligament (UCL), the majority of which was UCL scarring/remodeling. 70% of pitchers and 60% of position players had evidence of an olecranon osteophyte. Increased signal within the ulnar nerve was common in pitchers (40%) but rare in position players (4%). For the shoulder, 95% of pitchers and 93% of position players had some rotator cuff abnormality (often tendinosis within the supraspinatus and infraspinatus muscles). Also, 75% of pitchers had MRI evidence of a superior labrum anterior to posterior (SLAP) tear, while 24% of position players demonstrated this. Lumbar spine MRI showed that 47% of position players had a disk protrusion and 46% had a previous pars fracture. Conclusion: Most baseball players who participated in the 2023 MLB Combine had MRI evidence of rotator cuff abnormalities, and many showed evidence of an olecranon osteophyte. Eighteen percent of pitchers had a previous history of elbow surgery. The majority of pitchers had some abnormality within their UCL and evidence of a SLAP tear on MRI scans.

The opinions and assertions expressed herein are those of the authors and do not reflect the official policy or position of the Uniformed Services University or the Department of Defense. The mention of trade names, commercial products, or organizations does not imply endorsement by the Department of Defense, nor the U.S. Government. The authors have no relevant financial interests, activities, relationships, and/or affiliations to disclose. The data that support the findings of this perspective are personal observations or publications available in PubMed.