16 April 2012

OOTP13 is an Inside the Park Homerun

Outside of the Park 13 is the latest in a long running baseball computer game series ($39.99;
http://www.ootpdevelopments.com/out-of-the-park-baseball/).  The appeal of this games is that you are able to personally run an entire franchise.  Depending on how involved you would like to be, you could be as micromanaging as dictate how every lineup, depth chart, pitching decision, and player acquisition move plays out in your organization or you can hand your majors, minors, and scouting to your hired personnel while you focus on simply making trades.  It can be a very detailed playing experience for you or one that is quite pedestrian.  It all depends on how you want to run it.  Regardless (as best as I can tell), the game play takes time because the program actively seeks out player moves and simulates every single game from short season rookie ball to the majors.

That depth is where the title of this post comes from.  It is an impressive game, but it requires a great deal effort to truly maximize the games' potential.  It has been years since I last was into the whole gaming experience.  I cut my teeth on the original Nintendo and became rather unbeatable on several Super Nintendo games (I maintain Super Castlevania IV is the greatest game ever and I am ashamed as to occasionally wishing I had the soundtrack).  My last foray was an interest in playing Halo at a flat I rented with a couple other people during the first year of my doctoral studies.  Beyond that, softball, long distance running, foreign films, and traveling have become passions that have pushed out games for me.  Outside of the Park 13 piqued my interest because I wondered how well it could project seasons...something for which I do not think it is truly designed.

The current version of the game has the entire major and minor league rosters (with injuries) as of Opening Day.  The new CBA is fully integrated into the league rules and, after playing one season, the Houston Astros will move to the AL West.  The universe is also expanded to the inclusion of professional baseball in Japan as well as other actual international leagues (these other international leagues are populated with fictionalized players, I think).

For those who love to game, there is a real time simulation mode that gives a GM's perspective of what is happening in real time.  This includes updates of games in progress, notifications of important events, and other tidbits.  It was designed to give more meaning to the end of the season.  They also have put in something called an interactive storyline where players do things like lash out at the media or other teammates while the GM must consider where punishment in meted out.  There is also online play that many people enthusiastically play.

In the 40 or so hours I played the game, the only peculiar thing I found was that I could make one kind of seemingly unfair deal.  This is a great improvement over other games I had played in the past where you could stack countless non-prospects or bench players for cheap, good players.  The deal I found possible was that if I had a player who was average or below average and I had about three or four years left at 15MM, it was possible to deal said player for someone who was worthless at about 20MM.  From my perspective that is a steal because it saves the team 25MM while giving up someone who was going to be a deadweight on the team.  That...is the only hangup of the AI that I found I could exploit.

As someone who enjoys projection systems, I found other aspects of the game to be more interesting.  Although I may disagree with the projections, the outcomes are actually pretty consistent with what looks to be a rather realistic bell curve as projections go.  I ran through ten season simulations and kept track of several players.  Although the game does present WAR...I found it to be peculiar in how I would imagine WAR to be, so that will be a question I will be asking them later on.  Instead, I will present FIP and batting slash lines

Weiters 262/328/431
Andino 247/303/353
Reynolds 224/312/504
Betemit 266/340/458
Hardy 257/298/412
Reimold 260/319/447
Jones 280/322/473
Markakis 283/347/422

Arrieta 5.15
Hammel 4.70
Matusz 4.58
Chen 4.08

All of those numbers look reasonable to me.  The standard deviation varies slightly depending on the player, but the typical range would be +/- .020 for BA and OBP and +/- .030 for SLG.  Standard deviation for FIP ranged from 0.32 to 0.75.

The Orioles wound up winning between 67 and 73 games 90% of the time.  They were not the worst team 20% of the time.  AL East crowns went to the Yankees four times with the Red Sox, Rays, and Blue Jays at two a piece.  Six times the AL East had a wild card team with an additional two times having both wild card teams.  The Yankees and Brewers were considered the favorites to make the World Series with three appearances a piece.

Median Win Values in 10 Simulations
AL East
Yankees 95
Red Sox 89
Rays 86
Jays 85
Orioles 70

AL Central
Tigers 84
Royals 79
Indians 74
White Sox 72
Indians 71

AL West
Rangers 95
Angels 89
Mariners 78
A's 74

NL East
Phillies 90
Braves 87
Marlins 87
Nationals 87
Mets 71

NL Central
Reds 90
Brewers 85
Cardinals 77
Cubs 76
Pirates 68
Astros 67

NL West
Dodgers 85
Diamondbacks 84
Giants 82
Rockies 82
Padres 70

Should You Buy It?
I think if you are looking for a game that doubles as an easy simulator, then it is difficult to justify this game as being the right tool for you.  However, if you want a simulator that enables you to take a role as a GM and enjoy a realistic game, then this is right up your alley.  I am thoroughly impressed with the attention to detail in this game.  After a Baseball Prospectus article came out in February about the value of pitch framing in catcher, the development crew for this game immediately incorporated the concept.  That is impressive and that sort of comprehensive attention is an element of this game that to my knowledge has no peer.  Of course, we do not know whether we can adequately project such abilities, but I think you have to applaud the development team for considering these attributes and trying their best incorporate them.

I am planning on using the game as a simulator as the season progresses, but it will be difficult for me to do so.  It shall be interesting to see how many times I will be able to use it to provide answers to questions that pop up in my head.

12 April 2012

How Good is an NL Ace?: Mean Performance of Pitchers by Slot

There is a series of articles by Jack Sackman that you can find here.  It is an idea I found interesting an often use when I describe pitchers as a certain type of slot pitcher.  I think in common use a person referring to a guy as a one slot pitcher is more or less actually saying that the guy is a one slot pitcher on a first division team.  In other words, an ace on one of the ten best teams in baseball.  In this series of posts, I plan on going through each division and describing what each slot means and how that relates to teams.
AL East | Central | West
NL East | Central | West
NL Summary of Slots

In this post we will go through and look at four team FIP performances for each slot: median, first division cut off, best, and worst.  The following relates to numbers produced in 2011.

Slot 1
An NL pitcher at this slot could be described as:

Median 3.15
67th 3.24
33rd 3.05
The Nationals' Jordan Zimmerman (3.16 FIP) is your typical ace pitcher.  Philadelphia Phillie Cole Hamels (3.05 FIP) would be the threshold first division ace and Cardinal Jaime Garcia (3.23 FIP) would be the closest to a bottom rung ace.  In 2011, the Phillies had the best ace (Roy Halladay 32g 2.20 FIP) and the Astros were the worst (Lucas Harrell 2g 3.27 FIP; Bud Norris 30g 4.02 FIP).

Slot 2
An NL pitcher at this slot could be described as:

Median 3.62
67th 3.79
33rd 3.48
The average Slot 2 pitcher would be the Brewers Yovani Gallardo (3.59 FIP).  Reds' Ace Johnny Cueto (3.45 FIP) is the threshold first division second slot.  New Yankee Hiroki Kuroda (3.78 FIP) would qualify as a bottom threshold second slot pitcher.  The team with the best slot 2 performance are the Philles again (Cliff Lee 32g 2.60 FIP) and the worst was the Pirates (Paul Maholm 23g 3.78; Brad Lincoln 8g 3.88 FIP; Aaron Thompson 1g 3.95 FIP).

Slot 3
An NL pitcher at this slot could be described as:

Median 3.91
67th 4.05
33rd 3.73
Your typical three is the Cubs' Ryan Dempster (3.91 FIP).  The first division gate keeper is the Brewers Shawn Marcum (3.73 FIP).  Jason Marquis (4.05 FIP) would be the bottom rung three man.  The Phillies again have the best performance for the slot (Cole Hamels 31g 3.00 FIP; Vance Worley 1g 3.24 FIP) and the worst was, once again, the Pirates (Jeff Karstens 26g 4.29 FIP; James McDonald 6g 4.68 FIP).

Slot 4
An NL pitcher here can be described as:

Median 4.23
67th 4.55
33rd 4.08
Jhoulys Chacin (4.23 FIP) of the Rockies is the pitcher that embodies the meaning of the fourth slot.  The Brewers' Chris Narveson (4.06 FIP) would be your threshold 4 man and the Phillies' Kyle Kendrick (4.55 FIP) would be your lower tier line.  The Phillies once again set the tone here with the best 4 slot squad (Vance Worley 20g 3.24 FIP; Roy Oswalt 12g 3.44 FIP) and the worst was the Reds (Mike Leake 7g 4.21 FIP; Sam LeCure 4g 4.57 FIP; Edison Volquez 20g 5.29 FIP; Bronson Arroyo 1g 5.71 FIP).

Slot 5
An NL pitcher here can be described as:

Median 4.64
67th 5.27
33rd 4.41
The median 5 slot pitcher would be the Mets' Dillon Gee (4.65 FIP).  Your first division fiver was the fellow Met Mike Pelfrey (4.47 FIP) and the bottom third gate keeper was the Reds' Edison Volquez (5.29 FIP).  The Phillies sweep the slots (Roy Oswalt 11g 3.44FIP; Joe Blanton 8g 3.55 FIP; Kyle Kendrick 13g 4.75 FIP) in better fashion than the Orioles who rated last across the board. The team with the worst back end performance in the NL was the Diamondbacks (Joe Saunders 5g 4.78; Wade Miley 7g 4.79 FIP; Micah Owings 4g 4.85 FIP; Jason Marquis 3g 6.91; Barry Enright 7g 6.98 FIP; Armando Galarraga 6g 7.29 FIP).

AL Average Rotation
1 - Jordan Zimmerman, Nationals
2 - Yovani Gallardo, Brewers
3 - Ryan Dempster, Cubs
4 - Jhoulys Chacin, Rockies
5 - Dillon Gee, Mets

AL First Division Threshold Rotation
1 - Cole Hamels, Phillies
2 - Johnny Cueto, Reds
3 - Shawn Marcum, Brewers
4 - Chris Narveson, Brewers
5 - Mike Pelfrey, Mets

11 April 2012

2012 Draft Coverage: Finding 1:4, weekly pref list (April 11, 2012)

No travels over the holiday weekend, which means it was a video weekend for the 1:4 pref list. My focus was on starting to narrow down this top 15 list into a more manageable top 10. In addition to reviewing video I've taken on all of these players (totaling over 50 videos), I was able to catch-up on some game film I've had stored on the computer and in some cases on my DVR. Below are some quick thoughts on the guys currently situated 6-10, and what could cause them to rise-up or get cut from the pref list in the coming weeks. Also, I've included reasoning for dropping players 11-15 from consideration:

Still in the running:
Albert Almora (of) -- Easily the most impressive HS outfielder for me through the summer and fall. Lacks the ceiling of Buxton, but much more refined actions in the field and at the plate. Direct to contact, good plane, and shows pop in a projectable frame. Instincts in the outfield are great and reads off the bat are already average or better by Major League standards.

Gavin Cecchini (ss) -- Focused player with through-the-roof make-up. Business-like approach to the showcase circuit and performed well throughout each stop. I liked that he elected to use wood in the HS game I recently attended, but he expanded his strikezone and failed to square what should have been highly over-matched pitching (including a shaky freshman making his first ever appearance for the varsity squad). I'm relying on the summer/fall showings in projecting the bat to be top-ten worthy, and the glove/arm/actions/instincts make short the easy position to project to.

Carlos Correa (ss/3b) -- Big pop and big arm strength. His approach is a work-in-progress, though he has helped his cause over the past 9-months, shortening his load without losing the violence in his barrel delivery. The result is a shorter swing with comparable torque and a little more time to pitch-ID. Looks like a third baseman, long term, but if you believe in the bat (I do) you could have a "60" player between the offensive and defensive profile.

Luc Giolito (rhp) -- Elbow strain makes him a wildcard, but he's easily the highest-ceilinged arm on the board for me. Giolito has shown growth from his coming out party during the 2010 Area Code Games to the summer circuit and winter workouts. He isn't likely to be a fast-move candidate, but the wait should be worth it. Once he gets everything working together in his motion, he could be a plus to plus-plus velocity guy at 85% effort.

Deven Marrero (ss) -- Beware narratives! Marrero hasn't been hitting, but we do have a history of seeing him perform, including with wood. The trend right now is to for media outlets to come up with a reason that Marrero has struggled this spring. The truth is that he has always been a slightly better hitter with wood than with BBCOR, and even with wood he has never really looked like + hit or + power guy. You're buying positional certainty, advanced feel, and saved money on development.

Missing the cut:
Max Fried (lhp) -- Projectable, advanced secondaries, but limited "now" velocity and consistency. Fried is exactly the type of player I hope to get a shot at in the middle-third of the first round or lower, but lacks the probability to really match-up with the players that will be available in the top 5.

Stryker Trahan (c) -- The defense was just too rough in the spring check-in for me to keep him in the discussion for selection in the top 5 overall. The power is legit, and big, and his athleticism could allow him to play an outfield corner (likely left field) if he has to scoot out from behind the dish. Some folks close to Stryker had very positive comments regarding his make-up, work ethic, and overall character.

Zach Eflin (rhp) -- Spring helium guy that was overlooked more than he should have been in the fall down in Jupiter. The velocity jump is nice, but certainly not surprising, considering the arm speed, frame, and easy motion. The same, there are three legit college arms with better "now" stuff and more probability. It doesn't make sense to keep a follow on Eflin in that context when, essentially, you're looking for Eflin to develop into one of those college arms.

David Dahl (of) -- Potential five-tool package that just misses manifestation in-game, from my looks. His speed plays down some due to some inconsistency in his routes, and he can get too pull-happy at the plate. Almora and Buxton present higher probability and ceiling, making Dahl redundant on our follow list. That said, he's the type of player that, two years from now, people might scratch their head and wonder how he was available at 15th overall.

Walker Weickel (rhp) -- Projection guy in the summer that saw some slide down in Jupiter and a full step back this spring. His ceiling now isn't any lower than it was in the summer (top high school arm in the draft), but he hasn't taken that big step forward yet, and the safer bet is still Giolito. Like Eflin, Weickel just doesn't offer enough over the college trio to make his continued follow worthwhile.

On to the 1:4 pref list:

Current Preference List (April 11, 2012)
1. Mark Appel, rhp, Stanford Univ.
2. Byron Buxton, of, Appling County HS (Baxley, Ga.)
3. Kevin Gausman, rhp, Louisiana St. Univ.
4. Kyle Zimmer, rhp, Univ. of San Francisco
5. Mike Zunino, c, Univ. of Florida
6. Albert Almora, of, Mater Acad. (Hialeah Gardens, Fla.)
7. Lucas Giolito, rhp, Harvard-Westlake HS (Studio City, Calif.)
8. Gavin Cecchini, ss, Barbe HS (Lake Charles, La.)
9. Carlos Correa, ss/3b, Puerto Rico Baseball Acad. (Gurabo, P.R.)
10. Deven Marrero, ss, Arizona St. Univ.

Dropped out:
11. Max Fried, lhp, Harvard-Westlake HS (Studio City, Calif.)
12. Stryker Trahan, c, Acadiana HS (Lafayette, La.)
13. Zach Eflin, rhp, Hagerty HS (Chuluota, Fla.)
14. David Dahl, of, Oak Mountain HS (Birmingham, Ala.)
15. Walker Weickel, rhp/1b, Olympia HS (Fla.)

For today's draft video, here's a look at Carlos Correa(ss/3b, Puerto Rico Baseball Acad., Gurabo, P.R.) in action down in Jupiter:

Will This Be the Decade of the Offensive Catcher?

If you graph the number of seasons catchers had a 125 OPS+ or higher by decade, you get this graph:

If one was to believe in cyclical production at catcher, you would have the impression that the 2011-2020 decade will produce about 26-30 seasons of catchers hitting better than 125 OPS+.  Much of this production would be placed on the backs of Brian McCann, Matt Wieters, Carlos Santana, and Buster Posey.  I can see those four accounting for maybe 12-16 seasons.  That is a mighty strong base crop of catchers.  In the 1930s, the production was largely resulting from Mickey Cochrane, Gabby Hartnett, and Bill Dickey.  In the 1970s, Johnny Bench and Ted Simmons led the charge.

10 April 2012

Cup of jO's (April 10, 2012): Thoughts on Matusz's Start

It wasn't the start that O's fans were hoping for, but as one data point it wasn't terrible. We'll go in-depth on 2012 Matusz once he has accumulated three or four starts, but some quick thoughts for today:

- Overall Matusz's stuff was good, though he was at times inconsistent with his implementation.

- This was among his best showings this year (including Spring Training) with regards to release point. He was highly consistent finding the same slot and release point for his four offerings, which aided in his deception and allowed a 90 mph fastball to miss some good bats.

- The curve and slider were, at times, above-average to plus. His focus moving into start two will be commanding each better to both sides of the plate.

- His change-up wasn't really there for him, though it appeared this was more a result of him not turning it over consistently. As a feel pitch, it's more likely he just didn't have it last night than it is there are long term issues with the offering.

- I counted 9 to 11 pitches that could have easily been called strikes that were not. Pitch fx put the number at 8 no-doubters (significantly in the strikezone) that were not called strikes. This is part of the game, but against a patient and opportunistic line-up like the Yankees, you can bet you are going to run into trouble if it takes you are required to get four or five strikes past a hitter in order to retire him.

Overall, it was a middle-of-the-road start, scouting-wise, and an ugly start from a stat-line perspective. Matusz next matches up against the Jays on Sunday -- we'll hope he maintains the quality of his pitches while improving the placement of his secondaries.

09 April 2012

Cup of jO's (April 9, 2012): The O's, via Tom Scocca

What I'm reading...
Just a quick hit today, as we gear up for the O's series against the winless Yankees. Tom Scocca (Deadspin.com) published an Orioles-centric piece last Friday that is worth a read for every Orioles fan out there. In fact, I'd argue it is a therapuetuc read for any fan base suffering through seasons of losing.

Scocca opens the piece with a look back at the fantastic win that closed out the 2011 season and relegated the Red Sox to an October at home. What follows is an insightful look into the plight that has been the experience of the Orioles fanbase these last 14-years. In conclusion, he offers up a tentatively optimistic view of the current Orioles, their current management, and their 2012 campaign.

Maybe the real undervalued asset was in hiring an unwanted veteran general manager, rather than the sixth- or eighth-best whiz kid on the whiz-kid market. Duquette seems to be trying to get ahead however he can, not angling to position himself to implement a long-range plan to create a future window of opportunity. The long view doesn't require you to grab Zelous Wheeler off waivers at the last minute.

The reason you grab Zelous Wheeler and Matt Antonelli and Nick Johnson is so that, at some point this year, when Chris Davis or Mark Reynolds unleashes his violent, unsound swing and for once connects with the ball, it will be a two-run home run instead of a solo shot, because someone ahead of him has drawn a walk. You do it so that the Red Sox pitchers have to throw three or four extra pitches in an inning.

These are little things. The 27th out in the 162nd game of a losing season is a little thing, too. Until you refuse to concede it.

Make no mistake, the author does not claim the Baltimore fans should start printing playoff tickets. But it is a nice look at the organization for people who haven't necessarily been paying attention to Baltimore for the last decade or so. It's a balanced piece that leans a little to the rosier side of things -- not the tilt that O's fans are used to reading outside of fanbase blogs. Give it a read.

Coming soon...
Thursday will mark a new experimental series for us. I will prepare advance scouting reports for readers to view prior to an Orioles series. The series will serve less as an introduction to the Orioles opponents than it will a true advance scouting compilation, highlighting strengths and weaknesses of individual players. We'll give it a go and see what you all think.

06 April 2012

Opening Day 2012: In-game Chat!

Jon and I are discussing how to switch things up a bit this year and keep presentation of content fresh. As a result, we punted on any big Opening Day blowout piece, projecting the season or selecting Orioles award winners. Instead, I am going to open up a chat in this space for the first half of the game (perhaps more). It's late notice, I know, but if you are reading this, please stop by 30 minutes prior to the game and we will talk 2012 Orioles, prospects and draft.

To the extent chat participation lags today due to the excitement of the game, I'll add some scouting thoughts, as well. Starting with the Yankees series, I'll also be preparing (hopefully at the beginning of each series) an advance scouting report on the team Baltimore is facing.

Happy Opening Day; hopefully see many of you in a couple of hours!

05 April 2012

2012 Draft Coverage: Finding 1:4, Weekly Pref List (April 6, 2012)

Apologies for the delay in updating the pref list -- I had an extended trip in Louisiana followed by an avalanche of work at the office. The good news is that, in addition to it being opening day, we have first hand updates on Kevin Gausman (rhp, LSU), Gavin Cecchini (ss, Barbe HS, Lake Charles, La.) and Stryker Trahan (c, Acadiana HS, Lafayette, La.).

Stop one on my Bayou baseball bender was Gavin Cecchini in action against Carencro High School in Lafayette, La. Cecchini was clean in the field and, as always, had a focused approach. He oozes confidence and comfort, and was effortless when tested. Most impressive on the day was his ability to turnover two difficult double-plays while registering solid velocity readings on the throw to first. It was far from an impressive display at the plate, as Cecchini struggled to square-up well below-par pitching, keeping open that bit of doubt that his offensive profile is top ten worthy (even at the shortstop position). Still, he remains one of the best make-up kids in the top of the class and should have no trouble sticking at short. He hit and hit well throughout the summer showcase circuit and in Jupiter, so his struggles on Thursday were more of a disappointment than a red flag.

Friday night saw Kevin Gausman take the mound for LSU against Arkansas. Gausman has shown some inconsistency throughout the first month of the season, but for the better part of 6.2 innings threw like a potential 1:1 arm last Friday. The LSU ace climbed to 98 mph with his fastball in the first and generally sat 94-96 mph for the remainder of the game. The biggest growth in Gausman's game since he was drafted out of high school in 2010 has been in his secondaries. Each of his breaking balls and his change-up all had above-average moments, and four of his final six strikeouts (he totaled twelve) came on sliders that he set-up beautifully with his fastball. Gausman has the highest ceiling of the top three college arms in this draft class, and is a legit option for Houston with the first overall pick. Over the next two months he'll look to show consistency and try to avoid the temporary lapses in command that can cause his stuff to hug too much of the plate.

The final pref list target I took in while in Louisiana was Acadiana catacher Stryker Trahan. Trahan was one of the most impressive performers this past summer, showing plus raw power and enough athleticism and arm strength to project at catcher, long term. Saturday's showing was not a strong one for the Ole Miss commit, and he showed an inability to corral almost anything in the dirt behind the plate, and had difficulty handling throws from the outfield. He flashed multiple pop times on the north side of 2-seconds -- primarily as a result of inconsistent footwork that cut-off his release -- but did manage to break off a 1.85 before the day was out. At the plate, Trahan was generally pitched around, but was able to show off his raw pop and ability to let the ball travel with a monstrous opposite field homerun. There is a lot to like about Trahan, but he struggled enough behind the plate to at least raise a question as to whether he has the feel to stick at catcher, long term.

One unfortunate note before jumping to the current preference list: Ohio prep southpaw Matt Smoral may be out the rest of the season after being diagnosed with a stress fracture in his foot. I've made the decision to drop him off the list, as it looks like he will likely not be able to throw prior to the draft, and had enough questions surrounding his game that I don't think it makes sense to consider him at 1:4 with no opportunity for him to show advances in his development. I'm still very much a believer in his ability, but he should no longer be considered a viable candidate for Baltimore. I've added Florida prep righty Zach Eflin in his place -- more on Eflin in the coming weeks.

Below is my updated preference list for 1:4 targets. In two weeks we will narrow to ten targets; the first week of May we will narrow to five targets.

Current Preference List (April 6, 2012)
1. Mark Appel, rhp, Stanford Univ.
2. Byron Buxton, of, Appling County HS (Baxley, Ga.)
3. Kevin Gausman, rhp, Louisiana St. Univ.
4. Kyle Zimmer, rhp, Univ. of San Francisco
5. Mike Zunino, c, Univ. of Florida
6. Albert Almora, of, Mater Acad. (Hialeah Gardens, Fla.)
7. Lucas Giolito, rhp, Harvard-Westlake HS (Studio City, Calif.)
8. Gavin Cecchini, ss, Barbe HS (Lake Charles, La.)
9. Deven Marrero, ss, Arizona St. Univ.
10. Max Fried, lhp, Harvard-Westlake HS (Studio City, Calif.)
11. Carlos Correa, ss, Puerto Rico Baseball Acad. (Gurabo, P.R.)
12. Stryker Trahan, c, Acadiana HS (Lafayette, La.)
13. Zach Eflin, rhp, Hagerty HS (Chuluota, Fla.)
14. David Dahl, of, Oak Mountain HS (Birmingham, Ala.)
15. Walker Weickel, rhp/1b, Olympia HS (Fla.)

Dropped-out: Matt Smoral, lhp, Solon HS (Solon, Ohio)

For today's draft video, here's the new addition to the pref list (Zach Eflin) in action at the WWBA World Championship in Jupiter this past October:

03 April 2012

Science of Baseball: Zach Britton and Platelet Rich Plasma Injection

It was reported that Zach Britton was going to undergo platelet rich plasma injection on his shoulder to treat inflammation.  This event has been covered by Brittany Ghiroli and Andrew Gibson.  Britt's post includes a couple interviews and focuses on a pedestrian understanding of the process, why you might choose to do this over a cortisone injection, and its efficacy.  It is a solid mainstream article on PRP.  You should click on the link above and read it.  Andrew's article, in a way, provides greater context to the procedure and you should read that one as well.

I have been asked to write on this by a few of my readers as I tend to write about scientific matters in baseball and this sort of thing speaks to my training.  My research at the UMD-B's Medical School was focused on reproduction and DNA damage, but my class room training was a bit broader.  This should clue you in on my perspective in that how I typically see things differently than a medical doctor.  The best way I can explain it is that from my experience a medical doctor acts more as an advocate for the patient than as a strict scientist.  This means that they tend to believe in the benefit of procedures before the science can weigh in on the matter.

Another comparison is the PED issue in baseball.  There are the advocates (e.g. players, gym rats) and the science.  Sometimes the advocates get ahead on a specific issue, such as steroids improving athletic performance.  When the advocates get ahead of the curve though, they tend not to fully understand the procedure and can misapply it.  Thus, a poorly understood application of steroids could result in worse performances.  There is actually still much debate as to how effective steroids were for hitters generating power as well as other purported usage.  There is still misinformation out there as to how steroids affects head size and eye sight.  Science has largely caught up with this treatment and how to effectively use it in a clinical setting, but that often poorly translates as the message is transcribed into the gym locker room.

I do not see myself as an advocate.  You probably already know this from my previous writings on PEDs.  I like to see solid proof of something working.  This means getting into the nuts and bolts, understanding the science with a critical view.  After a quick overview, I will delve into some more recent journal articles.

Although summarized in Britt's and Andrew's articles, I think it might be beneficial to actually see an application of PRP.  In the video below, a physician uses the treatment for a patient with tendinitis in the elbow.  Tendinitis is an acute injury to the tendon that is accompanied by inflammation. 

For Zach Britton, the inflammation is in his shoulder as opposed to his elbow. With the information we have at hand, it is difficult to know exactly what kind of damage has occurred.  In fact, the physicians are probably unsure as well due to not being able to observe any damage.  I think the two most likely issues would be minor tearing in his rotator cuff or a small lesion in his labrum.  It might also have something to do with the biceps tendon, but I think that would be less likely than the other two.  With a minor injury, it may be difficult to determine what exactly is the cause.  As you can see, it is a rather busy joint.

The few articles I will be reviewing focus on injuries far more severe than what Britton currently has.  There really are no good studies that evaluate the efficacy of PRP on minor injuries.  The scant research available has been focused on major injuries, such as rotator cuff tears requiring surgery and ruptures of the Achilles tendon.  I will focus on two recent ones: a study on rotator cuff repair and another on a comparison between different injection techniques.  I will then follow up with my own thoughts on the treatment.

Platelet-Rich Plasma Augmentation for Arthroscopic Rotator Cuff Repair
Castricini et al. AJSM

One thought about the slow healing process with any sort of tendon tear is that the tissue is poorly vasculated.  In other words, little blood is getting to the area.  Blood carries all sorts of proteins and other chemicals that aid in the healing process.  The hypothesis is then that by concentrating the components of the blood largely responsible for healing (e.g., insulin growth factor, thrombin) and then applying them to the surgical site that it would then result is greater healing.

In this study, they are not looking at cases similar to Zach Britton's.  They are looking at tears that required surgery.  In this study, 88 patients were included with 45 given PRP in the form of a fibrin matrix.  Basically, you use a polymerized fibrin matrix so that you are able to physically connect it to the repaired area.  This is different from Britton's treatment where his PFP is not in a fibrin matrix and is instead directly injected at the site of inflammation.  The PRFM look like this:

What they found was that after 16 months, there was no difference between the group that was given a PRFM and those that did not have that aspect of the treatment.  However, the two caveats would be that these individuals were not athletes and rate of recovery within those 16 months was not evaluated.  Another, more recent, article looked at the same procedure with a 12 month follow up and found no difference between groups of similar treated patients with the lone exception that the PRFM group had a greater likelihood for retears.  These fall in line with the perspective of the physician that Britt interviewed.  However, another study that would have done better with a bit larger of a sample size found that PRP (they injected the PRP and then used sterile air to form a clot) may be useful for low grade tears, but not more significant ones.

Again, Britton does not fit in any of these categories.

Growth Factor-based Therapies Provide Additional Benefit Beyond Physical Therapy in Resistant Elbow Tendinopathy
Creaney et al. 2011 BJSM

This article focuses on patients who have not found any success with traditional physical therapy techniques to heal their elbows.  The researchers decided to compare PRP with ABI.  PRP again is the injection of concentrated platelets and growth factors while ABI is whole blood injection.  There was no control, placebo control, or comparison to a well known technique, such as administration of cortisone.  The researchers felt it was not ethical to have a group in the study that would not receive any treatment.  They found that both PRP and ABI produced similar results.  They both had a success rate around 70% (success defined as improvement in a Tennis Elbow Evaluation metric) over the course of six months (injection was at 0 and 1 month).  This looks like a solid result, but it hurts not having a control or traditional treatment comparison.

One of the first rules in treating someone is to do no harm.  This is where I divide PRP from something like hGH.  I have a difficult time seeing how currently applications of PRP could be dangerous to the patient.  I think there is also some data out there that suggests that PRP might be of some use to the healing process.  There are issues with knowing whether or not it works or how to use it best.  For instance:
  • No information on the level of concentration that is important for creating the PRP fraction,
  • No observations of the mechanisms of action for this treatment,
  • Few randomized studies and the existing randomized studies do not show a clear benefit, and
  • No consensus on injection site or frequency.
Treatment mechanisms in the past have been relatively simple to explore with increasing red blood cells, anabolic steroids, catabolic steroids, or hGH.  As I have covered before, responses to mixtures is a bit more difficult to measure.  The most interesting work in PEDs right now is work on hGH combined with testosterone (which similar to hGH alone does not seem to improve athletic performance).  With platelets, you have a much more complex set of growth factors and other proteins.  There remains great uncertainty.

It might work for Britton, it might not.  We really do not know.  If he gets betters, it does not mean it worked.  If he gets worse, it does not mean it didn't work.

02 April 2012

News and Notes

by Tom Peace

The Orioles are five days away from Opening Day and the ballclub still needs to make some roster moves. Here are the moves the have made in the last week to get ready for the season.

The long wait is over on who will be the Opening Day starter for the Baltimore Orioles. Jake Arrieta was given the nod from manager Buck Showalter to take the hill this Friday against the Minnesota Twins.  Arrieta started in 4 games this spring for the ballclub going 1-0 with a 6.14 ERA.  Though, the right-hander stuck out 12 batters and only walked 4.

Starting pitcher Chris Tillman was optioned to AAA Norfolk. The right-hander had moderate spring training. According to Orioles.com, the Orioles want him to be a starter and get some more innings down on the farm before being brought back up to the majors.

The Orioles’ designated Dana Eveland, 28, for assignment last week after going 1-2 with a 3.46 ERA in six games (three starts). The Orioles then claimed utility infielder Zelous Wheeler off waivers from the Milwaukee Brewers.

Baltimore acquired Eveland in a trade during the Winter Meetings back in December. Wheeler, in five Minor league seasons batted .271 and had a .371 OBP. The young third baseman is another example of Executive Vice President Dan Duquette going after high on-base percentage guys.

The chances of non-roster invitee, catcher Ronny Paulino making the 25 man Opening Day roster improved this past week as Taylor Teagarden was placed on the disabled list.  Teagarden hasn’t played in a game since March 6th and will have a second epidural in his lower back.

AL Team FIP by Pitching Postion

Keep an eye on the y-axis.  It changes from one graph to the next.  Also, the order of the teams change as well except for the Orioles who ranked as having the worst pitching by slot for every slot.

First Slot

Second Slot

Third Slot

Fourth Slot

Fifth Slot

As a little extra...here is the Orioles xWAR vs the World

Click to Enlarge