Paper 47: Return to play and performance following shoulder labral repair in major league baseball players

Objectives: Return to play (RTP) and performance following labral repair in Major League Baseball (MLB) athletes remains poorly defined, particularly when considering both pitchers and position players. To date, most research on labral injuries in MLB players has focused on RTP, workload, and more traditional baseball performance metrics. Traditional measures-such as earned run average (ERA) for pitchers or batting average for hitters-fail to account for nuances throughout the game and thus can cloud the evaluation of a player's true performance. Modern advanced analytics allow for a more comprehensive evaluation of post-operative performance. Despite these new advanced metrics more accurately assessing player performance, they have been minimally studied following shoulder labral repair. Therefore, the primary objective of this study is to assess RTP and return to performance (RTPf) following labral repair in MLB pitchers and position players using modern advanced analytic and Statcast metrics. Our secondary objective was to find any pre-operative predictors of returning to performance.
Methods: A total of 67 MLB players (39 pitchers, 28 position players) who underwent arthroscopic labral repair were identified between March 1, 2017 and December 1, 2024 then compared to 78 matched control pitchers and 56 matched control position players. RTP rates and timing were recorded for all players. RTPf analysis was performed for athletes with at least two seasons of complete pre- and post-operative advanced analytic data, resulting in 20 pitchers and 21 position players included as cases for RTPf analysis. Various traditional, advanced analytic, and ball-tracking metrics were analyzed for the first two seasons after returning from injury and compared to the season prior to injury. Unpaired and paired t tests compared pre- and post-operative performance, along with matched controls. Binary logistic regression identified predictors of returning to fWAR and full performance.
Results: Overall, 64.2% of all players returned to MLB play, with RTP rates significantly lower for pitchers than position players (43.6% vs 92.9%, p <0.05) and longer (493 vs 285 days, p<0.05). There were no significant differences in any offensive or defensive metric for position players pre- versus post-operatively. For pitchers, there were no differences in velocity, spin, movement, arm angle, approach angle, release point or extension. Pitchers struggled to regain their overall value (fWAR) and form in pitch quality (Stuff+), command (Location+), and overall pitching ability (Pitching+) following shoulder labral repair.
Conclusions: Overall, our findings demonstrate that while over 90% of position players return to MLB play within two years, less than half of pitchers return to play and on average require over 200 more days than position players to do so. Furthermore, while position players mostly returned to performance after returning to play, pitchers often struggled to return to their pre-injury performance even after two seasons back from injury. Pitchers struggled to return to workload, provided less than 50% of their pre-operative value (fWAR) to teams, and demonstrated significantly worse pitch quality (Stuff+), pitching command (Location+), and overall pitching ability (Pitching+). The present study provides a comprehensive review of return to play and return to performance after labral repair in both MLB pitchers and position players using a number of advanced analytic and ball-tracking metrics for the first time.