364 Artificial Turf Versus Grass in NCAA Football: Increased Knee Injuries Traded for Cost Savings to Schools

Abstract

Artificial turf is spreading, accounting for > 80% D1 football fields. Knee injuries make up a significant portion of injuries in NCAA Football. The impact of artificial playing surfaces on knee injury incidence remains unclear. This is the largest review determining differences in injury rates for knee ligament and meniscal injuries during NCAA Football events on natural grass(grass) and artificial turf (turf). The NCAA Injury Surveillance System (ISS) Men’s Football Data 2004-2014 seasons was analyzed to determine the occurrence of ACL, PCL, MCL, medial meniscus, and lateral meniscus tear injuries. Athlete-exposures (AEs), injury rates calculated based on frequency of each injury/10,000 AE. Rate ratios (RR) for each injury on turf versus grass determined whether playing surface had effect on prevalence of injury, for competition or organized practice. 3,009,205 AE and 2460 partial or complete knee injuries were reported in NCAA football: 2004-14: MCL tears (1,389), ACL tears (522), lateral meniscal tears (269), medial meniscal tears (164) and PCL tears (116). ACL tears increased 27% (RR = 1.27, 95% CI 1.07 - 1.51) on turf versus grass(p<0.02). PCL tears increased 108% (RR = 2.08, 95% CI 1.41 - 3.10) on turf (p<0.01). MCL, medial meniscus, and lateral meniscus tears trended higher on turf(p=NS). Turf-related knee injuries increased in lower Division:D II: 125% increased ACL. D III :, 308% increased PCL tears. Overall, knee injury rates increase on turf compared to grass. ACL and PCL injuries were significantly increased from turf and there is a discrepancy between Football Divisions. Significance:Turf is greatly replacing grass as a playing surface and yet, more knee injuries are occurring from it.