Kriz John P, DeFroda Steven, Staffa Steven J, Kriz Peter K
Wheaton College, Norton, Massachusetts, USA.
Division of Sports Medicine, University of Missouri, Columbia, Missouri, USA.
Am J Sports Med. 2023 Mar;51(4):926-934. doi: 10.1177/03635465221150509. Epub 2023 Feb 13.
Showcase participation has been considered a risk factor for elbow injuries. It remains unclear whether high school (HS) showcase volume negatively affects pitchers' career paths. Because pitchers are achieving 90 mph thresholds at younger ages, it is unknown whether shorter time intervals between achieving 90 mph thresholds and dates of ulnar collateral ligament reconstruction (UCL-R), known as time to tear (TTT), may affect career trajectory.
Elite pitchers with higher HS showcase volumes would be less likely to reach Major League Baseball (MLB) level compared with elite pitchers with fewer HS showcase appearances. Elite pitchers with longer TTT intervals would be more likely to achieve MLB level.
Cohort study; Level of evidence, 3.
Demographic, HS showcase and professional performance, and injury data from pitchers selected in the first 5 rounds of the MLB draft (2011-2017) were gathered from publicly available databases. Continuous and categorical variables were compared for the following subgroups: UCL-R group and pitcher group not undergoing UCL-R; "early" and "late" UCL-R groups; and pitchers achieving and pitchers not achieving MLB level. Multivariable analysis was performed using logistic regression. Standard deviations of ±1 SD were used to define early career versus late career UCL-R subgroups after normal distribution was confirmed (Shapiro-Wilk test; = .227). The early UCL-R group was defined as those pitchers undergoing UCL-R ≤-1 SD from the mean age at first injury (group mean age, 19.43 years), whereas the late UCL-R group was defined as ≥+1 SD from that age (group mean age, 25.19 years).
Of 611 pitchers, 455 (74.5%) had HS showcase performance data, and 608 (99.5%) had professional performance data. In total, 184 (30.1%) pitchers underwent UCL-R. Fewer pitchers who underwent early UCL-R achieved the MLB level compared with pitchers who underwent late UCL-R (48.1% vs 86.2%; = .006). Elite pitchers who pitched in ≥10 showcases in HS had half the odds of achieving the MLB level compared with pitchers who participated in <10 HS showcases (adjusted odds ratio, 0.50; 95% CI, 0.29-0.86; = .012). For every year longer that an elite pitcher did not tear his UCL after achieving the 90 mph threshold at an HS showcase (TTT after 90 mph [per year]), the likelihood of achieving the MLB level increased by 24% (adjusted odds ratio, 1.24; 95% CI, 1.02-1.52; = .032).
Higher HS showcase volume in elite pitchers was associated with a lower likelihood of achieving MLB level. A longer TTT after 90 mph (per year) was significantly associated with achieving MLB level in elite pitchers.
参加展示活动被认为是肘部损伤的一个风险因素。目前尚不清楚高中（HS）阶段展示活动的高参与量是否会对投手的职业生涯产生负面影响。由于投手在更年轻的年龄就能达到每小时90英里的速度门槛，所以在达到每小时90英里速度门槛与尺侧副韧带重建（UCL - R）日期之间的较短时间间隔（即撕裂时间，TTT）是否会影响职业生涯轨迹尚不清楚。
与高中阶段展示活动参与量较少的精英投手相比，高中阶段展示活动参与量较高的精英投手进入美国职业棒球大联盟（MLB）的可能性较小。TTT间隔较长的精英投手更有可能达到MLB水平。
队列研究；证据等级，3级。
从公开数据库收集美国职业棒球大联盟选秀（2011 - 2017年）前5轮选中的投手的人口统计学、高中展示活动及职业表现和伤病数据。对以下亚组的连续变量和分类变量进行比较：UCL - R组和未进行UCL - R的投手组；“早期”和“晚期”UCL - R组；达到和未达到MLB水平的投手。使用逻辑回归进行多变量分析。在确认数据呈正态分布（Shapiro - Wilk检验；P = 0.227）后，使用±1标准差来定义职业生涯早期与晚期UCL - R亚组。早期UCL - R组定义为那些在首次受伤平均年龄≤ - 1标准差时接受UCL - R的投手（组平均年龄，19.43岁），而晚期UCL - R组定义为在该年龄≥ + 1标准差时接受UCL - R的投手（组平均年龄，25.19岁）。
在611名投手中，455名（74.5%）有高中展示活动表现数据，608名（99.5%）有职业表现数据。总共有184名（30.1%）投手接受了UCL - R。与晚期接受UCL - R的投手相比，早期接受UCL - R的投手达到MLB水平的人数更少（48.1%对86.2%；P = 0.006）。在高中阶段参加≥10次展示活动的精英投手达到MLB水平的几率是参加<10次高中展示活动的投手的一半（调整后的优势比，0.50；95%置信区间，0.29 - 0.86；P = 0.012）。对于一名精英投手在高中展示活动达到每小时90英里速度门槛后其UCL未撕裂的时间每延长一年（90英里/小时后的TTT[每年]），达到MLB水平的可能性增加24%（调整后的优势比，1.24；95%置信区间，1.02 - 1.52；P = 0.032）。
精英投手中高中展示活动参与量较高与达到MLB水平的可能性较低相关。90英里/小时后的TTT（每年）较长与精英投手达到MLB水平显著相关。
