A modern advanced analytic approach to cost and performance loss analysis of ulnar collateral ligament surgery to Major League Baseball teams.

Background: Ulnar collateral ligament (UCL) surgery has become increasingly prevalent among Major League Baseball (MLB) pitchers. While its clinical implications have been extensively studied, the economic and performance impact on MLB teams remains incompletely understood. Methods: Cost analysis on all MLB pitchers who underwent UCL reconstruction between 2014 and 2024 was conducted. Pitchers were identified, and data were collected using public databases affiliated with MLB and used in previous studies. Economic losses were calculated using 2 primary components: (1) salary cost of recovery (COR), which quantified salaries paid to injured players during recovery, and (2) performance cost, a metric we defined using common FanGraphs wins above replacement (fWAR) conversions to estimate lost player contributions. Results: During the study period, a total of 276 UCL surgeries were performed from 2014 to 2024. Over the past 5 seasons (2020-2024), the number of UCL reconstructions in MLB pitchers has significantly increased to an average of 29.0 ± 4.7 surgeries per year compared to 21.8 ± 4.3 surgeries per year the 6 seasons prior (2014-2019; Conclusion: UCL injuries that require surgery impose an increasingly significant financial burden on MLB teams, leading to the loss of $1.26 billion dollars in salary paid out to injured players and likely over $3 billion worth of performance value lost to injury to teams over 10 years. Players also struggle to provide the same value in fWAR as they did prior to injury. This study shows that investing in UCL prevention and recovery efforts can potentially save teams, players, and local communities millions of dollars.