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Background: Nonoperative management versus early reconstruction for partial tears of the medial ulnar collateral ligament (MUCL) remains controversial, with the most common treatment options for partial tears consisting of rest, rehabilitation, platelet-rich plasma (PRP), and/or surgical intervention. However, whether the improved outcomes reported for treatments such as MUCL reconstruction (UCLR) or nonoperative management with a series of PRP injections justifies their increased upfront costs remains unknown., Purpose: To compare the cost-effectiveness of an initial trial of physical therapy alone, an initial trial of physical therapy plus a series of PRP injections, and early UCLR to determine the preferred cost-effective treatment strategy for young, high-level baseball pitchers with partial tears of the MUCL and with aspirations to continue play at the next level (ie, collegiate and/or professional)., Study Design: Economic and decision analysis; Level of evidence, 2., Methods: A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 young, high-level, simulated pitchers undergoing nonoperative management with and without PRP versus early UCLR for partial MUCL tears. Utility values, return to play rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at the authors' institution. Outcome measures included costs, acquired playing years (PYs), and the incremental cost-effectiveness ratio (ICER)., Results: The mean total costs resulting from nonoperative management without PRP, nonoperative management with PRP, and early UCLR were $22,520, $24,800, and $43,992, respectively. On average, early UCLR produced an additional 4.0 PYs over the 10-year time horizon relative to nonoperative management, resulting in an ICER of $5395/PY, which falls well below the $50,000 willingness-to-pay threshold. Overall, early UCLR was determined to be the preferred cost-effective strategy in 77.5% of pitchers included in the microsimulation model, with nonoperative management with PRP determined to be the preferred strategy in 15% of pitchers and nonoperative management alone in 7.5% of pitchers., Conclusion: Despite increased upfront costs, UCLR is a more cost-effective treatment option for partial tears of the MUCL than an initial trial of nonoperative management for most high-level baseball pitchers., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.F.O. has received consulting fees from Kaliber.ai. A.J.K. has received support for research from Aesculap/B.Braun; consulting fees from Arthrex, Joint Restoration Foundation, and Responsive Arthroscopy; speaking fees from Arthrex; honoraria from Joint Restoration Foundation; royalties from Arthrex and Responsive Arthroscopy; and a grant from DJO. K.R.O. has received consulting fees from Arthrex, Endo Pharmaceuticals, and Smith & Nephew; support for education from Gemini Medical, Arthrex, Endo Pharmaceutical, Pinnacle, Medwest Associates, and Zimmer Biomet; and hospitality payments from Stryker, Wright Medical Technology, and Medical Device Business Services. G.M. has received consulting fees from Smith & Nephew. C.L.C. has received consulting fees from Arthrex, research support from Major League Baseball, and royalties from Springer. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

The aims of this study were: 1) to describe the total muscular injuries, and specifically HSIs, and their corresponding missed matches; 2) to analyse their economic impact; and 3) to estimate the loss of incomes due to TV rights, in first division clubs from LaLigaTM depending on the expected and actual ranking position during the 2018/2019 season. To do that, a cross-sectional study for season 18/19 and for all players of the 20 Spanish professional football clubs was performed. The economic impact of injuries was estimated considering the missed matches and salary cost of all players and the audio-visual income loss was estimated considering the Spanish Royal Decree of Law (RDL 5/2015). The high number of muscular (270) and hamstring injuries (57) implies a high cost for professional first division football clubs, specifically € 365,811 per month for the former and € 47,388 per month for the latter. In addition, reaching a worse than expected position in LaLigaTM ranking involved a loss of 45,2 million € in TV rights incomes. The high cost of muscle injuries in first division teams justifies the need for multidisciplinary teams that are capable of reducing the number of injuries as well as recovery times., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nieto Torrejón et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Provide an overview of the methods used to estimate the cost of sports-related injury published to date, and to highlight considerations and opportunities for future research., Design: Scoping review., Methods: Scopus, MEDLINE and CINHAL were searched from 1st January 2000 to 1st January 2023. Studies were screened by two independent reviewers and were eligible if they reported on a cost analysis or cost estimation of sports related injury., Results: Thirty-one studies fulfilled the inclusion criteria. Twenty-seven studies (87 %) were published since 2014. The type of costs included direct healthcare costs (12 studies), indirect costs (10 studies) and a combination of both (9 studies). Twenty-one studies (68 %) used a bottom-up costing approach to measure costs of sports injury and estimated direct costs from the service rates or fee schedules of health systems, hospital, insurance companies or national insurance boards. A top-down approach was used in seven studies (23 %) to estimate the indirect salary cost of time-loss injuries using data from publicly available resources. Ten studies were from the cost perspective of a sporting organisation (32 %). There was a lack of explicit reporting of the costing method used and the perspective of those bearing the costs., Conclusions: Estimating the cost of sports injuries is an emerging area of research, with publications increasing in recent years. However, there remains a lack of methodological guidance to inform or appraise these studies. The expansion of established cost of illness checklists with sport injury explanations to guide future cost of sports injury studies is recommended., Competing Interests: Declaration of interest statement The authors of this review declare that there are no competing interests. The authors also declare that this scoping review is not under consideration for publication elsewhere, that its publication is approved by all authors and that if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)