High-Velocity Changeups and Sweeper Usage Are Associated With Increased Odds of Undergoing Arthroscopic Shoulder Labral Repair in Professional Baseball Pitchers

OBJECTIVE: The objective of this study was to determine whether pitch-specific characteristics, including velocity, spin rate, and pitch type usage, are predictive of arthroscopic shoulder labral repair (ASLR) in major league baseball (MLB) pitchers. DESIGN: A retrospective analysis was conducted using MLB pitchers who underwent ASLR between 2016 and 2024. Pitch metrics were collected from Baseball Savant, a baseball sabermetric database, and compared with healthy league averages. Mann-Whitney U-tests and logistic regression were used to assess differences and predictors of ASLR. SETTING: Major league baseball. PARTICIPANTS: Twenty-seven pitchers met the inclusion criteria by having Baseball Savant data from the season before undergoing ASLR. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Preinjury pitch metrics, including velocity, spin rate, movement profiles, and pitch usage. RESULTS: Twenty-seven pitchers who underwent ASLR were compared with 6444 healthy league-average pitchers. Pitchers who threw changeups at higher velocities had increased odds of ASLR [P = 0.0028; odds ratio (OR) = 1.263]. Greater use of low-velocity changeups (P = 0.0279; OR = 0.942) and other off-speed pitches (P = 0.0058; OR = 0.929) was associated with lower odds of undergoing ASLR, whereas higher sweeper usage (P = 0.0194; OR = 1.071) was associated with increased odds. CONCLUSIONS: Major league baseball pitchers who threw higher-velocity changeups demonstrated increased odds of undergoing ASLR. In contrast, those who threw a higher proportion of lower-velocity changeups and other off-speed pitches, and fewer sweepers, showed decreased odds of labral repair.