Thank you for having me. Dr. Steven DeFroda from University of Missouri going to be talking about our experience looking at ulnar collateral ligament tear in elite Major League Baseball players and the association with their showcase participation in high school. No relevant disclosures. So quick introduction as everyone is aware in Major League Baseball the UCL tear is kind of becoming this quote unquote epidemic and it's happening at younger and younger ages. There's a host of risk factors mostly due to overuse, average velocity and just fatiguing these pitchers who are pitching year round, throwing harder, throwing more often. What was the purpose of our study? We wanted to look at high school showcase participation data in players who then went on to participate at the Major League Baseball level and our hypothesis was those pitchers who achieved a higher fastball velocity specifically 90, 92 and 95 miles an hour earlier would tear their UCL earlier in their professional career and we also hypothesized that Major League players who had higher showcase participation in high school would be more likely to undergo UCL reconstruction at some point in their professional career. So in our methods we looked at pitchers who were selected in the first five rounds of the Major League Baseball draft over a ten year time period. We pulled their data off of publicly available sources for injury and statistical metrics. We also pulled their high school showcase performance data from common websites such as Perfect Game and Prep Baseball Report which tracks all of this data for scouts for the professional athletes. We only included showcases in which they participated. Here's kind of the statistical analysis. The age of our UCL tears was normally distributed so we also utilized this to specialize two certain groups looking at the quote-unquote early tear and the quote-unquote late tear which was defined as one standard deviation above and below the average age of the UCL tear and specifically look at those groups for their own risk factors. What were our results? We were able to find 845 pitchers who were selected in that ten year time period. 659 of them did have data on the showcase websites that we listed there. So a good amount of pitchers did have data available. This is how the data shows up when we look at those websites. There's Garrett Cole who I'm sure you've all heard of the New York Yankees. We mostly look at fastball velocity data. We also look at slider velocity data as well as ages when pitchers began throwing their slider. Here's our results of the entire cohort. About 27% had a UCL reconstruction at some point in their career. That's in line with a lot of the data reported on Major League Pitchers which reports a tear rate of about 25%. The average age of tear is about 22 or so years plus or minus there. In our early and late groups which I mentioned we defined, obviously much lower and much higher. 19 for the early group, 24.8 for the late group. What were our results? The pitchers who achieved fastball velocity greater than 90 miles per hour were more likely to undergo UCL reconstruction than pitchers who did not. And this was also true for the 92 mile an hour fastball velocity. It wasn't for the 95 for some reason. We also found that the peak fastball velocity in the high school showcase data was higher in the group that went on a tear than the ones that didn't tear. Is this clinically significant? I guess you could argue one way or another. But obviously these guys are throwing much harder and they're probably throwing a lot of innings. This table is not the easiest to comprehend. But just when you look at the earlier late tear, first late tear kind of comments in state of the pitchers who were throwing harder earlier were more likely to tear sooner. And then also the pitchers who were throwing in the early group, they threw a lot more showcases than the late tear group. So are these showcases dangerous for the pitchers? Potentially depending on the overuse. We found a lot of concerning trends over the 10 year period. The average age of UCL reconstruction dropped significantly over the 10 year period from almost 24 to 20. That's a pretty significant drop. The main age at first showcase participation also dropped, 16 and a half years to 15 and a half years. And you know, skeletal immaturity kind of occurs at that age range. So could that have something to do with this and something to do with these rise and these tears later in the career? We also found that the mean age in which pitchers were achieving this 90 mile an hour threshold dropped during the study period as well. And the mean number of high school showcases drastically increased over the 10 year period, 2.8 to 6. So once again, kind of a concerning trend, especially in the setting of more tears in younger athletes kind of going forward in their major league careers. Just kind of some points of discussion which I've kind of already hit. Peak fastball velocity was their strongest predictor, seen in a lot of our other studies in the major league level where fastball velocity is the most significant predictor of tear. The elite pitchers hitting that 90, 92 mile an hour threshold were more likely to tear at some point in their professional career. And that these are the factors that we found to be significant with tear. Age of first high school showcase, age of first showcase in their slider, age of throwing greater than 90 miles an hour. And then obviously the players who achieved those earlier were more likely to be in the early group versus the late group. Total number of the high school showcases attended by pitchers was significantly larger in the early group. 27% of pitchers tore in our cohort, like I mentioned, very much in line with the 25% we see in a lot of the major league data that's been reported. This is really the first study that did retrospectively look back at that showcase data to kind of find this correlation and find these trends which do kind of seem concerning, especially as these organizations such as Perfect Game become more and more popular for these younger youth athletes. So what were our main conclusions that we drew from this? Peak fastball velocity recorded at high school showcases was the strongest predictor of eventual UCL reconstruction in our elite level MLB throwers. Before initiating their careers, the pitchers who had more showcases earlier on were more likely to tear at a younger age. And we kind of led to conclude from this, you know, should we be looking at a cutoff when we're talking to our patients of really not trying to showcase these guys at an age younger than 16, maybe waiting until they're kind of done developing? And we kind of found too, you know, if you're going to throw this hard, you're probably going to make it pro anyway. Why are you throwing in six, eight, ten showcases and potentially blowing your arm out? So those are some of the conclusions we made and hopefully that can help you counsel your patients in this age demographic. Thank you to my co-researchers and thank you for having me.

Ulnar collateral ligament tear

Major League Baseball players

Showcase participation

Fastball velocities

UCL reconstruction