SARASOTA, Fla. As the number of elbow injuries for MLB pitchers has risen over the last few decades, so has the urgency in the medical community to find ways to hasten the recovery process and allow hurlers to return to form without undergoing reconstructive surgery. Leading the way in the field of biologics is the platelet-rich plasma (PRP) injection, a nonsurgical method Orioles pitcher Kyle Bradish opted for this offseason to heal a sprain of his ulnar collateral ligament (UCL).

Bradish, 27, suffered the injury in January when he began ramping up for the 2024 season. The right-hander was coming off a breakout season for Baltimore and the sprain, an injury that can require Tommy John elbow reconstruction, was a significant blow for an Orioles team with World Series aspirations. However, Bradishs decision to try PRP injections left open the possibility of him returning to the mound without enduring the lengthy rehab process of surgery.

Our plans are to get him pitching in 2024, Orioles executive vice president and general manager Mike Elias said at the clubs spring training complex ahead of spring training.

Pitching is a dangerous business nowadays. You never like to hear anybody have elbow or shoulder or wrist injuries or what have you. There are a lot of people who have [PRP injections] and never get surgery, and rest and other treatments do the trick. So, hopefully, thats where were at with this one.

The UCL is a ligament that runs along the inside of the elbow supporting both the stability and movement of the joint. When repaired with Tommy John surgery, the surgeon removes a healthy tendon from another part of the patients body and threads it through holes drilled into the bones on either side of the elbow. The typical recovery timeline for an MLB pitcher is anywhere between 12 and 18 months, often forcing them to miss entire seasons.

PRP injections gained popularity in 2009, when star athletes including Pittsburgh Steelers wide receiver Hines Ward and PGA golfer Tiger Woods received them to assist with their recoveries from knee injuries. Los Angeles Dodgers pitcher Takashi Saito, the first documented MLB player to receive the injections, returned to the field without pain two months after a doctor administered them and pitched for three more seasons. He never required Tommy John surgery.

Among the most famous cases of successful PRP treatments is that of Masahiro Tanaka, who received the injections on his elbow as a rookie in 2014 and went on to have a successful seven-year career with the New York Yankees. Philadelphia Phillies starter Aaron Nola decided to try PRP in August 2016 and he was ready for opening day the following season. Yet there are plenty of cases that dont work out as well. Two-way phenom Shohei Ohtani twice tried to avoid Tommy John using PRP injections and twice had to go under the knife anyway. Former Orioles pitcher Dylan Bundy was forced to undergo the surgery as a prospect two months after opting for PRP.

Thats just what the Orioles doctors and some other doctors we talked to said would be the best starting point based off of imaging and stuff and the amount of time we still had, Bradish said. There wasnt much research on my part or a thought process behind it besides just listening to the doctors.

The treatment, which renowned orthopedic surgeon Dr. James Andrews called the next major revelation in sports medicine, uses a patients blood to accelerate the healing process. The blood is drawn and spun down a centrifuge to separate the components. A doctor then removes the red blood cells and injects the remaining solution into the site of the injury, introducing the healing elements of platelets to areas that would not have been exposed to them otherwise.

Dr. Natalie Leong is an associate professor of orthopedic surgery at the University of Maryland School of Medicine who runs a research lab that studies regenerative medicine and biologic solutions to tendon and ligament injuries. Leong, who previously worked on the Chicago White Soxs medical staff, describes the injections as low risk for patients with ligament sprains, though she cautions against using them to heal full UCL tears.

Its interesting that we dont know exactly how PRP works, because its a fairly blunt instrument with many different growth factors, Leong said. The general idea is that theres a lot of growth factors in your blood that can affect healing and the PRP is a concentrated amount of growth factors that youre injecting into the area to help promote a healing response.

So, with a UCL injury, if you have a minor sprain, it can help heal that sprain. If its a complete tear of the UCL and its disconnected, there are some studies that have shown that sometimes it works but its much less likely to work.

A 2021 study published in the Orthopaedic Journal of Sports Medicine by six doctors, including Andrews, found that 61.5% of monitored athletes with Type I and II (partial) UCL tears who received PRP injections returned to the field without undergoing surgery. Those with Type III and IV (complete) tears saw a success rate of only 36.4%.

Whether a full recovery using PRP injections might still result in a pitcher eventually undergoing Tommy John surgery is a subject of debate among sports medicine professionals. Leong attests that the stress pitchers put on their elbow already puts them at high risk of tearing their UCL because of the repetitive nature of throwing. The unnatural overhand throwing motion used by pitchers puts a much larger strain on the UCL compared with the average person.

Most people, if we did not have an ulnar collateral ligament or if it was completely torn, we wouldnt even notice in activities of daily living, Leong said. But a pitcher will absolutely notice because of so much more force on the elbow, and not just the fact that its a lot of force, its that its a repetitive motion.

According to former FanGraphs analyst Jon Roegeles public Tommy John surgery database, the average number of MLB pitchers to undergo the procedure so far this decade is 28.8 per year. In the 2010s, that number was 21.3. The decade before, it was 15.6. Elbow injuries have become an epidemic among pitchers, and PRP is perhaps the most prominent method at their disposal with a track record of accelerating the recovery time for UCL sprains.

Elias did not elaborate on what grade of UCL sprain Bradish has, but the Orioles starter is hoping this still-emerging practice of biologics can help him make an impact in 2024. Though he has yet to progress to throwing on a mound, Bradish said the follow-up MRIs conducted by team doctors have shown accelerated healing and he has not felt any pain while playing catch on flat ground.

I think right now our hopes and focuses are on getting this behind him and getting him up and running for 2024, and we want to do it carefully and safely, Elias said. For that reason, Im not ready to slap a timeline on it.

Baltimore Sun reporter Jacob Calvin Meyer contributed to this article.

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Bradish latest pitcher to try 'low risk' PRP for UCL sprain - Baltimore Sun