Advanced Medical Procedures Following College Football Upper Extremity Surface Trauma On Artificial Turf And Grass

Abstract

With the perception of a higher incidence of injuries on artificial turf, and the potential for long term sequelae of sport injuries leading to increased medical costs as well, no long term studies have compared elective imaging and medical procedures following upper extremity (UE) trauma on artificial turf (AT) with natural grass (NG). PURPOSE: To quantify elective imaging and surgery following UE surface-related college football game trauma on AT and NG fields. METHODS: 39 universities were evaluated over 15 seasons (2006-2020) across all Football Bowl Subdivision (FBS) conferences. Playing surfaces were divided into two groups: a heavyweight AT infill system (≥9.0 lbs infill/ft2) and NG. Outcomes of interest included elective procedures across injury severity, primary type of injury, anatomical location, and extremity disorder. Data were subject to MANOVA and Wilks’ λ criteria, and expressed as incidence rates (lR) per 10 games. RESULTS: Of the 2,215 games documented, 1,097 games (49.5%) were played on the heavyweight AT and 1,118 games (50.5%) played on NG. In sum, of the 9,137 total injuries reported, 650 were UE surface-related cases, with 244 injuries reported on AT and 406 on NG. UE surface-related trauma on AT resulted in 123 elective imaging and 35 surgical procedures, with 172 imaging and 46 surgeries ordered following injuries on NG. MANOVA indicated significant main effects by advanced medical procedures (F3,291 = 4.436; P = .004) between surfaces. Post hoc analyses indicated significantly lower (P < .05) incidence of total UE surface-related trauma [2.2, (95% CI, 2.0-2.5) vs 3.6 (3.4-3.9)], substantial UE trauma requiring elective imaging [0.2, (95% CI, 0.1-0.3) vs 0.5 (0.4-0.6)], number of radiographs ordered [0.8, (95% CI, 0.7-1.0) vs 1.1 (1.0-1.3)], and elective imaging procedures combined [1.1, (95% CI, 0.9-1.3) vs 1.5 (1.3-1.8)] on heavyweight AT when compared to NG fields, respectively. CONCLUSION: The significantly lower incidence of injury and subsequent elective imaging following UE surface-related trauma during competitive play on heavyweight AT translates to lower health care costs than observed on NG surfaces. This is the first longitudinal study that directly compares and addresses elective medical procedures as they relate specifically to UE surface-related football injury.