Injuries among professional baseball players have been on the rise for several years.1,2 From 1989 to 1999, the number of disabled list (DL) reports increased 38% (266 to 367 annual reports),1 and a similar increase in injury rates was noted from the 2002 to the 2008 seasons (37%).2 These injuries have important implications for future injury risk and time away from play. Identifying these injuries and determining correlates and risk factors is important for targeted prevention efforts.
Several studies have explored the prevalence of upper extremity injuries in professional and collegiate baseball players;2-4 however, detailed epidemiology of knee injuries in Major League Baseball (MLB) and Minor League Baseball (MiLB) players is lacking. Much more is known about the prevalence, treatment, and outcomes of knee injuries in other professional sporting organizations, such as the National Basketball Association (NBA), National Football League (NFL), and National Hockey League (NHL).4-12 A recent meta-analysis exploring injuries in professional athletes found that studies on lower extremity injuries comprised approximately 12% of the literature reporting injuries in MLB players.4 In other professional leagues, publications on lower extremity injuries comprise approximately 56% of the sports medicine literature in the NFL, 54% in the NBA, and 62% in the NHL.4 Since few studies have investigated lower extremity injuries among professional baseball players, there is an opportunity for additional research to guide evidence-based prevention strategies.
A better understanding of the nature of these injuries is one of the first steps towards developing targeted injury prevention programs and treatment algorithms. The study of injury epidemiology among professional baseball players has been aided by the creation of an injury tracking system initiated by the MLB, its minor league affiliates, and the Major League Baseball Players Association.5,13,14 This surveillance system allows for the tracking of medical histories and injuries to players as they move across major and minor league organizations. Similar systems have been utilized in the National Collegiate Athletic Association and other professional sports organizations.3,15-17 A unique advantage of the MLB surveillance system is the required participation of all major and minor league teams, which allows for investigation of the entire population of players rather than simply a sample of players from select teams. This system has propelled an effort to identify injury patterns as a means of developing appropriate targets for potential preventative measures.5
The purpose of this descriptive epidemiologic study is to better understand the distribution and characteristics of knee injuries in these elite athletes by reporting on all knee injuries occurring over a span of 4 seasons (2011-2014). Additionally, this study seeks to characterize the impact of these injuries by analyzing the time required for return to play and the treatments rendered (surgical and nonsurgical).
Materials and Methods
After approval from the Johns Hopkins Bloomberg School of Public Health Institutional Review Board, detailed data regarding knee injuries in both MLB and MiLB baseball players were extracted from the de-identified MLB Health and Injury Tracking System (HITS). The HITS database is a centralized database that contains data on injuries from an electronic medical record (EMR). All players provided consent to have their data included in this EMR. HITS system captures injuries reported by the athletic trainers for all professional baseball players from 30 MLB clubs and their 230 minor league affiliates. Additional details on this population of professional baseball players have been published elsewhere.5 Only injuries that result in time out of play (≥1 day missed) are included in the database, and they are logged with basic information such as region of the body, diagnosis, date, player position, activity leading to injury, and general treatment. Any injury that affects participation in any aspect of baseball-related activity (eg, game, practice, warm-up, conditioning, weight training) is captured in HITS.
All baseball-related knee injuries occurring during the 2011-2014 seasons that resulted in time out of sport were included in the study. These injuries were identified based on the Sports Medicine Diagnostic Coding System (SMDCS) to capture injuries by diagnostic groups.18 Knee injuries were included if they occurred during spring training, regular season, or postseason play. Offseason injuries were not included. Injury events that were classified as “season-ending” were not included in the analysis of days missed because many of these players may not have been cleared to play until the beginning of the following season. To determine the proportion of knee injuries during the study period, all injuries were included for comparative purposes (subdivided based on 30 anatomic regions or types).
For each knee injury, a number of variables were analyzed, including diagnosis, level of play (MLB vs. MiLB), age, player position at the time of injury (pitcher, catcher, infield, outfield, base runner, or batter), field location where the injury occurred (home plate, pitcher’s mound, infield, outfield, foul territory or bullpen, or other), mechanism of injury, days missed, and treatment rendered (conservative vs surgical). The classification used to describe the mechanism of injury consisted of contact with ball, contact with ground, contact with another player, contact with another object, or noncontact.