Background: Biomechanical predictors of pitching accuracy are underevaluated in baseball research. It is unclear how pitchers with higher accuracy differ in terms of kinematics and upper extremity kinetics. Purpose: To differentiate high- and low-accuracy professional pitchers by full-body kinematic and upper extremity kinetic parameters. Study Design: Descriptive laboratory study. Methods: In total, 121 professional baseball pitchers threw 8 to 12 fastballs while assessed with motion-capture technology (480 Hz). Pitchers were divided into high-accuracy (n = 33), moderate-accuracy (n = 52), and low-accuracy (n = 36) groups based on the absolute center deviation of each pitcher`s average pitch to the center of the pitching chart by greater or less than 0.5 SD from the mean, respectively. The 95% confidence ellipses with comparisons of major and minor radii and pitching probability density grids were constructed. Analysis of variance was used to compare kinematic and kinetic values between groups. Results: The absolute center deviation (14.5% ± 6.7% vs 33.5% ± 3.7% grid width; P < .001) was significantly lower in the high-accuracy compared with the low-accuracy group, with no significant difference in ball velocity (38.0 ± 1.7 vs 38.5 ± 2.0 m/s; P = .222). Lead knee flexion at ball release (30.6°± 17.8° vs 40.1°± 16.3°; P = .023) was significantly less for the high-accuracy pitchers. Peak normalized shoulder internal rotation torque (5.5% ± 1.0% vs 4.9% ± 0.7% body weight [BW] × body height [BH]; P = .008), normalized elbow varus torque (5.4% ± 1.0% vs 4.8% ± 0.7% BW × BH; P = .008), and normalized elbow medial force (42.9% ± 7.3% vs 38.6% ± 6.2% BW; P = .024) were significantly greater for the low-accuracy group compared with the high-accuracy group. Conclusion: Professional pitchers with increased accuracy experienced decreased throwing arm kinetics. These pitchers had increased lead knee extension at later stages of the pitch, potentially providing more stable engagement with the ground and transference of kinetic energy to the upper extremities. Professional pitchers can consider increasing lead knee extension at the final stages of the pitch to improve the accuracy of their throws and mitigate elbow varus torque. Clinical Relevance: Increased elbow varus torque, shoulder internal rotation torque, and elbow medial force in less accurate pitchers may contribute to increased injury risk in this group.
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