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Is Fantasy Baseball Score A Viable Outcome Measure For Professional Baseball Pitchers After Undergoing Tommy John Surgery?

Open AccessPublished:October 29, 2022DOI:https://doi.org/10.1016/j.jseint.2022.09.018

      Abstract

      Background

      Although on-field performance metrics are useful in measuring overall success of ulnar collateral ligament (UCL) reconstruction (UCLR) in professional baseball pitchers, they may not comprehensively quantify athletic performance after returning to playing in the league.

      Purpose

      To utilize Fantasy Baseball Score (FBS) as a novel and objective outcome to assess the quality of return to play in Major League Baseball (MLB) pitchers who went back to professional pitching after UCLR.

      Methods

      This is a retrospective observational cohort study of 216 established MLB pitchers who underwent UCLR while in the MLB between the years 1974 and 2018. Pitchers who either started in at least 45 games or pitched 90 relief games in the 3 years leading up to injury were included. FBS was calculated using three different scoring methods: ESPN (FBS-ESPN), Yahoo (FBS-Yahoo), and CBS (FBS-CBS). Return to play, games played, innings pitched, earned runs, strikeouts, walks, hits allowed, hit batsman, and quality starts were also collected. Performance records were compiled for 3 years prior to and after return to MLB. Players pre-injury performance was used as a historic control group. Multivariate linear regression was used to detect trends between seasons, controlling for year of surgery and number of games.

      Results

      The mean age of the cohort at the time of surgery was 30.0±3.5 years. 179 of 216 players (83%) returned to MLB play, taking an average of 16.6±5.8 months. 136 of 179 (76%) remained in the league for 3 seasons. After adjusting for year of surgery, pitchers earned significantly fewer points for FBS-CBS (616.45±332.42 vs 389.12±341.06, p<0.001), FBS-Yahoo (801.90±416.88 vs 492.57± 428.40, p<0.001), and FBS-ESPN (552.76±275.77 vs 344.19±300.45, p<0.001) after their injury. Also pitchers played in fewer games, pitched fewer innings, and had a decline in all measured on-field performance statistics.

      Conclusion

      FBS may represent a useful outcome measure to objectively assess the quality of return to play in a professional baseball pitcher who returned to play in MLB after UCLR.

      Keywords

      Elbow ulnar collateral ligament (UCL) reconstruction (UCLR) has become increasingly utilized in the treatment of recreational and major league baseball (MLB) pitchers after UCL rupture

      Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med. 32(5):1158–1164. doi:10.1177/0363546503262166

      . Primary UCLR is generally successful in terms of return to play, patient-reported outcomes, and performance statistics for professional pitchers. The surgical technique of UCL reconstruction (UCLR) has evolved since its inception in 1974
      • Azar F.M.
      • Andrews J.R.
      • Wilk K.E.
      • Groh D.
      Operative treatment of ulnar collateral ligament injuries of the elbow in athletes.
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      • Lombardo S.J.
      Reconstruction of the ulnar collateral ligament in athletes.
      ,

      Rohrbough JT, Altchek DW, Hyman J, Williams RJ, Botts JD. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med. 30(4):541–548. doi:10.1177/03635465020300041401

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      Smith GR, Altchek DW, Pagnani MJ, Keeley JR. A muscle-splitting approach to the ulnar collateral ligament of the elbow. Neuroanatomy and operative technique. Am J Sports Med. 24(5):575–580. doi:10.1177/036354659602400503

      and overhead athletes have achieved excellent results, reported via the Conway score
      • Conway J.E.
      • Jobe F.W.
      • Glousman R.E.
      • Pink M.
      Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament.
      , 83% of the time with an overall complication rate of 10%
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      Elbow medial ulnar collateral ligament reconstruction: clinical relevance and the docking technique.
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      • Williams R.J.
      • Altchek D.W.
      Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes.
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      • Schafer M.F.
      • Keuter G.
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      Ulnar collateral ligament reconstruction in elite throwing athletes.
      ,
      • Paletta G.A.
      • Wright R.W.
      The modified docking procedure for elbow ulnar collateral ligament reconstruction: 2-year follow-up in elite throwers.
      ,

      Rohrbough JT, Altchek DW, Hyman J, Williams RJ, Botts JD. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med. 30(4):541–548. doi:10.1177/03635465020300041401

      ,
      • Vitale M.A.
      • Ahmad C.S.
      The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review.
      . Despite players having generally positive outcomes after UCLR, there still exists significant barriers for professional players to return to a pre-injury level of play
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      Players’ perspectives on successfully returning to professional baseball after medial ulnar collateral ligament reconstruction.
      .
      Surgical success has been reported using several injury-specific patient reported outcomes (PROs). One such score is the Conway score which grades the athlete as poor, fair, good, and excellent depending on their ability to return to prior level of play
      • Conway J.E.
      • Jobe F.W.
      • Glousman R.E.
      • Pink M.
      Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament.
      . Another is the Kerlan-Jobe Orthopaedic Clinic Score (KJOC score), consisting of a subjective questionnaire that grades an overhead athlete’s functional performance
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      Clinical follow-up of professional baseball players undergoing ulnar collateral ligament reconstruction using the new Kerlan-Jobe Orthopaedic Clinic overhead athlete shoulder and elbow score (KJOC Score).
      . Although these outcome measures are useful in measuring overall success, they may lack the ability to comprehensively quantify athletic performance amongst pitchers who have returned to the MLB, the highest level of play. Studies have also reported outcomes in terms of on-field performance statistics such as earned run average, innings pitched, etc
      • Marshall N.E.
      • Keller R.A.
      • Limpisvasti O.
      • ElAttrache N.S.
      Pitching Performance After Ulnar Collateral Ligament Reconstruction at a Single Institution in Major League Baseball Pitchers.
      . Individual on-field performance metrics may act as a surrogate for overall performance, but no study to date has created an outcome measure that integrates multiple on-field performance metrics into one score.
      Fantasy Baseball Score (FBS) has been shown to be reproducible and predictive of future performance on a season-to-season basis

      Herrlin DL. Forecasting MLB performance utilizing a Bayesian approach in order to optimize a fantasy baseball draft. 2015; Theses and Dissertations. LCC: QA75.2; Digital Identifier: http://hdl.handle.net/20.500.11929/sdsu:2238 no doi

      ,

      Huddleston SD. Hitters vs. Pitchers: a comparison of fantasy baseball player performances using hierarchical Bayesian models. 2012; Theses and Dissertations. Digital Identifier: https://scholarsarchive.byu.edu/etd/3173 no doi

      ,
      • Koseler K.
      • Stephan Matthew
      Machine learning applications in baseball: A systematic literature review.
      , we propose that FBS may be used as an objective outcome measure in high-performing professional baseball athletes. Fantasy points represent an objective and comprehensive measure of on-field performance as compared to individual performance statistics, which may provide an incomplete picture of overall performance. The purpose of this study is to demonstrate that FBS may be used to measure quality of return to play, from which elbow surgeons may use to counsel MLB pitchers regarding their expected performance outcomes after UCLR.

      Materials and Methods

      Generation of Study Cohort

      This is a retrospective observational cohort study of established MLB pitchers who underwent UCLR while in the MLB. In order to generate our study cohort, players were identified as having undergone UCLR using the following baseball databases: “Baseball Reference”, “Fangraphs”, “Baseball Cube”, MLB.com, and rostersource.com. Verification of UCLR was performed by one of the authors by searching for a corresponding publicly available press release. Due to the detrimental nature of UCL tear on professional performance, the MLB pitchers who have undergone UCLR are well documented in the public record (team press releases, newsprint, recorded statements by player, etc). All data is publicly available, and this study is exempt from institutional review board approval.
      Between the years 1974 and 2018, 426 players were identified as having undergone primary UCLR during their MLB career. Pitchers who did not start a minimum of 45 games or relief pitch in 90 games in three seasons prior to injury were excluded. These exclusion criteria were necessary to establish reliable baseline MLB performance prior to injury, which would be used as paired historic control for postoperative performance. Prior sabermetrics research (i.e. empirical analyses of baseball statistics) has found that FBS for pitchers is predictive of future performance on a season-to-season basis

      Herrlin DL. Forecasting MLB performance utilizing a Bayesian approach in order to optimize a fantasy baseball draft. 2015; Theses and Dissertations. LCC: QA75.2; Digital Identifier: http://hdl.handle.net/20.500.11929/sdsu:2238 no doi

      ,
      • Koseler K.
      • Stephan Matthew
      Machine learning applications in baseball: A systematic literature review.
      but there is high variance in scores with shorter playing time. The pitching position, compared with other positions, is subjected to high variability in score on a week-to-week basis. Any given pitcher may have a lapse in their gameplay and get pulled early from the game having accrued high numbers of negative points in a short period of time. Because of this phenomenon specific to MLB pitchers, the cutoff for minimum number of games played needed to be sufficiently high to use FBS as a mathematically reliable measure of baseline performance

      Huddleston SD. Hitters vs. Pitchers: a comparison of fantasy baseball player performances using hierarchical Bayesian models. 2012; Theses and Dissertations. Digital Identifier: https://scholarsarchive.byu.edu/etd/3173 no doi

      . 210 pitchers who failed to meet the inclusion and exclusion criteria, leaving a total of 216 players for analysis.

      Data Collection

      The primary outcome studied was FBS, calculated using three different scoring methods from the most popular fantasy baseball websites: ESPN (FBS-ESPN), Yahoo (FBS-Yahoo), and CBS (FBS-CBS). Table 1 lists pitching performance statistics used to tabulate score as well as the relative weights of each performance statistic. Scores were calculated by the authors using raw data from baseball database records. Using this methodology fantasy scores were generated for all pitchers, even those who played prior to the advent of fantasy baseball but who had sufficient records in the MLB databases.
      Table 1On-field Performance Metrics Included in Each Fantasy Baseball Scoring System and the Points Awarded for Each On-Field Metric.
      Fantasy Scoring SystemEarned RunStrike OutWalkHit AllowedInning PitchedHit BatsmanQuality Start
      ESPN-21-1-13Not IncludedNot Included
      Yahoo-33-1.3-1.33-1.3Not Included
      CBS-10.5-1-13-13
      Secondary outcome measures were return to MLB play, time to return to MLB play, games played, innings pitched, earned runs, strikeouts, walks, hits allowed, hit batsman, and quality starts. Return to MLB play was defined as playing in at least 1 MLB game after surgery. Quality starts are awarded to a player for pitching at least six innings and allowing less than three runs. Baseball-Reference.com was used to compile player demographics and performance statistics. Number of quality-starts were obtained from MBL.com. Performance records were compiled for 3 years prior to and 3 years after return to MLB. Nomenclature of seasons is relative to season of injury and return to MLB. For example, “pre-injury season 3” is in reference to three seasons prior to season of injury and “post-surgery season 3” refers to the third season after return to MLB. Fantasy score and performance statistics were recorded as per-season totals.

      Statistical Analysis

      Descriptive data are represented as means ± standard deviation (SD). Statistical differences in numeric and continuous variables were detected using paired 2-sided t-tests and analysis of variance (ANOVA), whereas a player’s pre-injury performance was used as a historic control for post-surgery performance. Multivariate linear regressions were used to detect trends between the 6 baseball seasons (3 pre-injury and 3 post-surgery). A multivariate model was used to adjust for year of surgery and number of games played due to the evolution in surgical technique and to account for the differences in the number of games a pitcher played before and after undergoing UCLR. Sub-group analysis of FBS, by decade, was performed by categorizing pitchers based on date of surgery into one of three subgroups: before 2000, between 2001 and 2010, and 2011 to present. This analysis was performed to assess the general effect of evolving surgical technique and rehabilitation protocols on outcomes. A p-value of less than .05 was considered to be significant. All statistical analyses were performed using SPSS, version 25 (IBM Corporation, Armonk, NY, USA).

      Results

      Demographics and Return to Play

      There were 426 who pitchers underwent UCLR while playing in the MLB and 216 met inclusion criteria for the study. At time of surgery, players were a mean age of 30.0 ± 3.5 years. Return to play analysis revealed that 179 of 216 players (83%) returned to MLB play, taking an average of 16.6 ± 5.8 months to return. Of the 179 players who returned to play in the MLB, only 136 (63%) remained in the league for 3 seasons after the season of injury.

      Fantasy Baseball Score Before and After Injury

      There was a significant decline in the number of fantasy points accrued when comparing the 3 seasons before injury to the 3 seasons after MLB return. After adjusting for year of surgery, pitchers earned significantly fewer points for FBS-CBS (616.45 ± 332.42 vs 389.12 ± 341.06, p<0.001), FBS-Yahoo (801.90 ± 416.88 vs 492.57 ± 428.40, p<0.001), and FBS-ESPN (552.76 ± 275.77 vs 344.19 ± 300.45, p<0.001) after their injury. Regarding individual on-field performance statistics, after surgery pitchers played in fewer games (120.68 ±57.52 vs 72.59 ±30.77, p<0.001), pitched fewer innings (338.06 ± 170.64 vs 223.56 ± 165.01, p<0.001), and had a decline in all measured on-field performance statistics including earned runs (144.02 ± 84.54 vs 102.13 ± 73.02, p<0.001), hits allowed (327.41 ± 181.83 vs 218.83 ± 166.42, p<0.001), walks (116.32 ± 60.63 vs 78.52 ± 51.32, p<0.001), hit batsman (11.12 ± 7.76 vs 8.09 ± 7.15, P<0.001), strikeouts (270.36 ± 128.38 vs 175.12 ± 126.20, p<0.001), and quality starts (22.00 ± 22.46 vs 12.82 ± 18.52, p<0.001). All metrics remained significantly different after controlling for both year and number of games played. Table 2 details pre-injury and post-surgery raw on-field performance metrics (Table 2A), as well as FBS totals and component scores for FBS-ESPN (Table 2B), FBS-Yahoo (Table 2C), and FBS-CBS (Table 2D)
      Table 2Comparison of On-Field Performance and Fantasy Points Accrued Over Three Seasons Prior to Season of Injury and First Three MLB Season s After UCLR (n=136)
      A: Raw On-Field Performance
      Before InjuryPost-Surgeryp-value
      Total Games Played120.68 ± 57.5272.59 ± 30.77<0.001
      Total Innings Pitched338.06 ± 170.64223.56 ± 165.01<0.001
      Total Earned Runs144.02 ± 84.54102.13 ± 73.02<0.001
      Total Hits Allowed327.41 ± 181.83218.83 ± 166.42<0.001
      Total Walks116.32 ± 60.6378.52 ± 51.32<0.001
      Total Hits Batsman11.12 ± 7.768.09 ± 7.150.001
      Total Strikeouts270.36 ± 128.38175.12 ± 126.20<0.001
      Total Quality Starts22.00 ± 22.4612.82 ± 18.52<0.001
      Total Fantasy Points
      B: ESPN Fantasy Points Comparison
      Before InjuryPost-Surgeryp-value
      Total Games Played
      Total Innings Pitched1,014.17 ± 511.91670.68 ± 495.03<0.001
      Total Earned Runs-288.03 ± 169.08-204.26 ± 146.05<0.001
      Total Hits Allowed-327.41 ± 181.83-218.83 ± 166.42<0.001
      Total Walks-116.32 ± 60.63-78.52 ± 51.32<0.001
      Total Hits Batsman
      Total Strikeouts270.36 ± 128.38-175.12 ± 126.20<0.001
      Total Quality Starts
      Total Fantasy Points552.76 ± 275.77344.19 ± 300.45<0.001
      C: Yahoo Fantasy Points Comparison
      Before InjuryPost-Surgeryp-value
      Total Games Played
      Total Innings Pitched1,014.17 ± 511.91670.68 ± 495.03<0.001
      Total Earned Runs-432.05 ± 253.62-306.39 ± 219.060.019
      Total Hits Allowed-425.63 ± 236.38-284.48 ± 216.35<0.001
      Total Walks-151.22 ± 78.83-102.08 ± 66.72<0.001
      Total Hits Batsman-14.46 ± 10.09-10.51 ± 9.290.001
      Total Strikeouts811.09 ± 385.15525.35 ± 378.59<0.001
      Total Quality Starts
      Total Fantasy Points801.90 ± 416.88492.57 ± 428.40<0.001
      D: CBS Fantasy Points Comparison
      Before InjuryPost-Surgeryp-value
      Total Games Played
      Total Innings Pitched1,014.17 ± 511.91670.68 ± 495.03<0.001
      Total Earned Runs-144.02 ± 84.54-102.13 ± 73.02<0.001
      Total Hits Allowed-327.41 ± 181.83-218.83 ± 166.42<0.001
      Total Walks-116.32 ± 60.63-78.52 ± 51.32<0.001
      Total Hits Batsman-11.12 ± 7.76-8.09 ± 7.150.001
      Total Strikeouts135.18 ± 64.1987.56 ± 63.10<0.001
      Total Quality Starts65.98 ± 67.3738.45 ± 55.57<0.001
      Total Fantasy Points616.45 ± 332.42389.12 ± 341.06<0.001

      By-Season Comparison of MLB Performance

      Primary and secondary outcomes were then compared by season using multivariate linear regression to control for both decade of surgery and number of games played (Table 3, Figure 1A, 1B, 1C). This analysis revealed that after undergoing UCLR, pitchers suffered a significant decline between pre-injury season 1 and post-surgery season 1 in games played (p<0.001), innings pitched (p<0.001), earned runs (p<0.001), hits allowed (p<0.001), walks (p<0.001), hit batsman (p<0.001), strikeouts (p<0.001), quality starts (p=0.001), FBS-CBS (p<0.001), FBS-ESPN (p<0.001), and FBS-Yahoo (p<0.001). The decline in FBS between pre- injury and post-surgery was maintained for post-surgery seasons two and three (Figure 1). For each of the FBS scoring methods a decline in performance was noted between pre-injury season 2 and season 1, leading up to the season of injury.
      Table 3Comparison of Pre-injury to Post-Surgery On-Field Performance and Fantasy Points by Season
      Pre-Injury S3Pre-Injury S2Pre-Injury S1Post-Surgery S1Post-Surgery S2Post-Surgery S3P-Value
      Games Played35.5 ± 27.444.0 ± 25.041.2 ± 21.934.3 ± 16.737.4 ± 21.134.5 ± 20.10.001
      Innings Pitched115.1 ± 64.8119.2 ± 66.5107.8 ± 70.882.0 ± 63.784.9 ± 63.686.4 ± 68.5<0.001
      Earned Runs48.0 ± 30.950.0 ± 33.447.3 ± 36.336.4 ± 27.537.1 ± 29.328.7 ± 31.7<0.001
      Hits Allowed110.2 ± 66.2114.8 ± 69.3106.5 ± 75.878.1 ± 58.983.8 ± 62.986.5 ± 71.7<0.001
      Walks38.6 ± 23.041.2 ± 24.138.9 ± 26.828.7 ± 18.131.4 ± 22.228.5 ± 21.1<0.001
      Hit Batsman3.2 ± 2.74.1 ± 3.43.9 ± 3.82.9 ± 2.53.4 ± 3.62.8 ± 2.90.004
      Strikeout90.3 ± 48.796.2 ± 52.486.7 ± 55.160.3 ± 40.063.6 ± 53.551.2 ± 55.6<0.001
      Quality Start7.7 ± 8.67.7 ± 8.56.6 ± 7.94.4 ± 6.44.9 ± 7.45.3 ± 7.80.001
      CBS Fantasy Points200.5 ± 138.3218.9 ± 132.3190.1 ± 136.0141.1 ± 146.5135.5 ± 133.2112.5 ± 135.3<0.001
      ESPN Fantasy Points179.3 ± 119.0197.8 ± 114.6170.0 ± 120.2124.7 ± 135.7119.7 ± 118.899.8 ± 118.5<0.001
      Yahoo Fantasy Points258.0 ± 176.4288.0 ± 176.1247.4 ± 181.3173.6 ± 165.6173.5 ± 179.2145.5 ± 174.7<0.001
      Figure thumbnail gr1
      Figure 1Line graph of mean total FBS per season. Error bars represent 95% confidence interval. Pre-injury season 1 (S1) denotes the season immediately prior to the season of injury and post-surgery S1 denotes the first season in which a pitcher returned to play in the MLB. Multivariate linear regression depicts down-trending mean FBS-ESPN (2A), FBS-Yahoo (2B), and FBS-CBS (2C) between pre-injury season 2 through post-surgery season 3. These associations were maintained despite controlling for number of games played per season and decade of surgery.

      Sub-Group Analysis by Decade

      A sub-group analysis, comparing fantasy performance by decade, was performed to determine if decade of surgery has a significant impact on post-surgical FBS. The subgroups pre-2000, 2001 to 2010, and 2011 to present were compared to reveal that the trend towards lower post-surgery FBS was maintained between the subgroups (Table 4).
      Table 4Sub-Group Analysis by Decade of Fantasy Points Production Pre-Injury and Post-Surgery
      Pre-Injury S3Pre-Injury S2Pre-Injury S1Post-Surgery S1Post-Surgery S2Post-Surgery S3P-Value
      Surgery Prior to 2000 (n=29)
      CBS Fantasy Points235.71 ± 138.32233.02 ± 124.77164.19 ± 127.45122.76 ± 84.47126.16 ± 131.46117.79 ± 122.93<0.001
      ESPN Fantasy Points200.62 ± 116.68196.79 ± 101.68134.35 ± 103.73105.59 ± 67.00106.86 ± 115.46103.00 ± 106.40<0.001
      Yahoo Fantasy Points261.53 ± 159.41257.07 ± 140.35169.29 ± 132.29135.17 ± 86.74142.40 ± 164.29146.14 ± 154.57<0.001
      Surgery Between 2001-2010 (n=46)
      CBS Fantasy Points198.20 ± 139.55208.32 ± 140.84198.09 ± 145.16164.44 ± 196.19143.15 ± 136.68100.42 ± 133.030.002
      ESPN Fantasy Points177.11 ± 121.15188.69 ± 119.96176.61 ± 129.96142.86 ± 187.38124.98 ± 120.8087.56 ± 113.000.001
      Yahoo Fantasy Points254.47 ± 182.64270.32 ± 178.86253.81 ± 198.76188.20 ± 208.81175.45 ± 180.04122.16 ± 157.90<0.001
      Surgery After 2011 (n=52)
      CBS Fantasy Points184.86 ± 136.76221.34 ± 129.22196.15 ± 132.08128.72 ± 112.80133.14 ± 132.90121.22 ± 144.75<0.001
      ESPN Fantasy Points170.54 ± 119.24206.94 ± 117.03182.65 ± 117.07117.49 ± 100.02121.56 ± 120.38109.69 ± 130.19<0.001
      Yahoo Fantasy Points259.42 ± 182.05320.94 ± 187.46282.41 ± 176.59180.08 ± 149.81187.94 ± 186.86167.25 ± 198.46<0.001

      Discussion

      Our study of established MLB pitchers who have undergone UCLR found the overall rate of return to MLB to be 83%, but that only 63% of the cohort remained in the MLB after three seasons. Of the pitchers who continued playing for at least three seasons, there was a significant decline in performance both in their first season returning and in the subsequent two seasons thereafter. Our study also showed a decline in fantasy performance leading up to their injury: a decline from pre-injury season 2 to season 1.
      Although return to same level of play is an essential outcome measure, it is equally important to objectively assess quality of return to play. To date, there is a paucity of comprehensive tools used to assess on-field athletic performance in MLB pitchers. PROs and pitching velocity have traditionally represented a useful way to measure surgical success, but KJOC or Conway scores may not directly correlate with on-field performance as they may lack the granularity to distinguish between high, mediocre, and poor performance levels once return to MLB has been achieved. Furthermore, the measurement of singular on-field performance metrices may fail to illustrate a complete picture of an individual’s performance. We propose that FBS may be used as a measure of a professional athlete’s overall performance and is a helpful adjunct to already established outcome measures that are currently used in this patient population. Fantasy baseball was initially popularized in the 1980s and although there are various methods for tabulating points, FBS is well established by fans, sabermetrics researchers

      Herrlin DL. Forecasting MLB performance utilizing a Bayesian approach in order to optimize a fantasy baseball draft. 2015; Theses and Dissertations. LCC: QA75.2; Digital Identifier: http://hdl.handle.net/20.500.11929/sdsu:2238 no doi

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      Huddleston SD. Hitters vs. Pitchers: a comparison of fantasy baseball player performances using hierarchical Bayesian models. 2012; Theses and Dissertations. Digital Identifier: https://scholarsarchive.byu.edu/etd/3173 no doi

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      Ulnar collateral ligament reconstruction in elite throwing athletes.
      ,
      • Makhni E.C.
      • Lee R.W.
      • Morrow Z.S.
      • Gualtieri A.P.
      • Gorroochurn P.
      • Ahmad C.S.
      Performance, Return to Competition, and Reinjury After Tommy John Surgery in Major League Baseball Pitchers: A Review of 147 Cases.
      ,
      • Paletta G.A.
      • Wright R.W.
      The modified docking procedure for elbow ulnar collateral ligament reconstruction: 2-year follow-up in elite throwers.
      . For our cohort, return to MLB level of play was 83% on average 16.6 months after surgery. It is also worth noting that 44 of the 216 (20%) of pitchers were able to return for at least 1 game but subsequently retired within 3 seasons.
      The current literature illustrates mixed outcomes regarding on-field performance after UCLR, with some studies reporting similar or improved performance after UCLR
      • Gibson B.W.
      • Webner D.
      • Huffman G.R.
      • Sennett B.J.
      Ulnar collateral ligament reconstruction in major league baseball pitchers.
      ,
      • Marshall N.E.
      • Keller R.A.
      • Limpisvasti O.
      • ElAttrache N.S.
      Pitching Performance After Ulnar Collateral Ligament Reconstruction at a Single Institution in Major League Baseball Pitchers.
      while others report a postoperative decline
      • Keller R.A.
      • Steffes M.J.
      • Zhuo D.
      • Bey M.J.
      • Moutzouros V.
      The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.
      ,
      • Makhni E.C.
      • Lee R.W.
      • Morrow Z.S.
      • Gualtieri A.P.
      • Gorroochurn P.
      • Ahmad C.S.
      Performance, Return to Competition, and Reinjury After Tommy John Surgery in Major League Baseball Pitchers: A Review of 147 Cases.
      . Our study is most consistent with the findings of Makhni et al, who found a sustained postoperative decline in performance. Makhni noted that of the 80% of pitchers who returned to MLB play, 57% returned to the disabled list and there was diminished performance in the two seasons following return to play
      • Keller R.A.
      • Steffes M.J.
      • Zhuo D.
      • Bey M.J.
      • Moutzouros V.
      The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.
      . This contradicts the findings of Marshall et al who found that pitching performance measures such as pitching velocity, innings pitched, earned runs average (ERA), and walks and hits per inning pitched (WHIP) returned to preoperative levels by the second year postoperatively
      • Marshall N.E.
      • Keller R.A.
      • Limpisvasti O.
      • ElAttrache N.S.
      Pitching Performance After Ulnar Collateral Ligament Reconstruction at a Single Institution in Major League Baseball Pitchers.
      . Interestingly, our study showed a decline in fantasy performance leading up to their injury (a decline from pre-injury season 2 to season 1). This phenomenon was observed in prior studies by Erickson and Keller et al
      • Erickson B.J.
      • Gupta A.K.
      • Harris J.D.
      • Bush-Joseph C.
      • Bach B.R.
      • Abrams G.D.
      • et al.
      Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers.
      ,
      • Keller R.A.
      • Steffes M.J.
      • Zhuo D.
      • Bey M.J.
      • Moutzouros V.
      The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.
      . A key difference to note is that our exclusion criteria eliminated a large number of pitchers who failed to establish a sufficient MLB track record prior to injury. Consequently, our findings as they relate to UCLR outcomes may have limited generalizability to all pitchers who are indicated for the procedure.
      In our study population, there was a postoperative decline in games played, innings pitched, and all on-field performance metrics including earned runs, hits allowed, walks, hit batsman, strikeouts, and quality starts. There was also a subsequent rebound in performance between post-injury season 1 and season 3 with regard to innings pitched, earned runs, hits allowed, and quality starts. Keller et al identified a similar trend where MLB pitchers exhibited an initial performance decline postoperatively, but their performance rebounded in the subsequent two seasons. Although, in Keller et al’s cohort most pitchers failed to achieve their pre-injury performance level
      • Keller R.A.
      • Steffes M.J.
      • Zhuo D.
      • Bey M.J.
      • Moutzouros V.
      The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.
      . For our cohort, FBS declined despite there being a discordance in improvement for different performance statistics, suggesting that changes in FBS were attributable to both pitching fewer innings per game and reduced overall performance while on-field. This may indicate that FBS appears to act as a barometer for a player’s overall performance throughout a season, capturing both a decline in innings pitched and quality of play.
      In order to account for evolution in operative technique over the years of the study, we performed a by-decade subgroup analysis to examine if pitchers fared better in recent decades as compared to those prior. In general, the overarching trend in which pitchers experience a preoperative decline from pre-injury season 2 to season 1, followed by a substantial decline for post-surgery season 1 is maintained. One notable divergence from this trend was noted for the 2011 to present subgroup, where there was an increase in FBS from post-surgery season one to two, followed by a significant decline in season 3 – a similar trend was seen in some studies conducted during the same time period
      • Keller R.A.
      • Steffes M.J.
      • Zhuo D.
      • Bey M.J.
      • Moutzouros V.
      The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.
      ,
      • Marshall N.E.
      • Keller R.A.
      • Limpisvasti O.
      • ElAttrache N.S.
      Pitching Performance After Ulnar Collateral Ligament Reconstruction at a Single Institution in Major League Baseball Pitchers.
      .
      Our study has several notable limitations that must be recognized. As this is a retrospective observational study of publicly available data, important surgical details such as experience of operating surgeon, technique utilized, concomitant procedures, and rehabilitation protocol were not available. To adjust for this, all analyses have been adjusted for year of surgery in order to offset this effect. We also assumed that surgeons treating MLB pitchers utilize fixation techniques and rehabilitation protocols that are consistent with the standard of care. Conway and KJOC scores or pitching velocity are not publicly available, and we are unable to correlate FBS to these previously established outcomes. It is possible that the injury database did not reveal every pitcher who underwent UCLR. Although this limitation is mitigated by the fact that UCLR is a major operation that requires years to return to play, resulting in the public knowledge of nearly all UCLR procedures for MLB players. Our exclusion criteria eliminated 210 MLB pitchers who hadn’t played in a sufficient number of games to reliably calculate FBS. Furthermore, most MLB pitchers who have undergone UCLR did so prior to professional play. The mean age of our study population was 30 years, and the mean age of MLB debut is roughly 25 years, suggesting that our cohort is comprised of established pitchers. Pitchers who are still in the league at age 30 have an MLB retention rate of 80.8% at 4-years. This is likely due to possibly to the fact that established pitchers may have a larger repertoire of pitches and have an improved capacity to adjust their game after UCLR as they age and experience diminished fastball speed. Whereas less experienced pitchers who undergo UCLR may be more susceptible to worse play in the context of diminishing fastball speed as they age. This must be considered because our outcome data may not necessarily represent all of the MLB pitchers who underwent this operation. Rather, our study design was aimed to demonstrate that FBS may be a useful measure of performance rather than to reiterate outcomes after UCLR surgery.

      Conclusions

      Fantasy baseball scores (FBS) may represent a useful outcome measure in the assessment of professional baseball pitchers’ quality of return to play, as it combines several on-field performance statistics into a singular objective score. This may augment the criterion that surgeons currently use to measure surgical success for UCLR. Further research may focus on FBS as a predictor of return to play and validation of FBS as an outcome measure for professional baseball players.

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