Incidence and Severity of Game-Related College Football Thoracoabdominal Injuries on Artificial versus Natural Grass

Abstract

In the past, serious injuries have been attributed to playing on artificial turf. Newer generations of artificial turf, however, have been developed to duplicate the playing characteristics of natural grass. No long-term studies have compared articular and muscle trauma of the thoracoabdominal region between the two surfaces. PURPOSE: To quantify incidence and severity of game-related thoracoabdominal collegiate football injuries on artificial turf vs natural grass. METHODS: A total of 24 universities were evaluated over 8 competitive seasons for injury incidence rates (IIRs) across injury severity, injury category, injury mechanism and situation, primary type of injury, anatomical location, type of tissue injured, elective imaging and surgical procedures, and turf age. RESULTS: Of the 1,237 collegiate games documented, 628 (50.8%) were played on artificial turf vs 609 (49.2%) played on natural grass. A total of 379 thoracoabdominal injuries were reported with 147 (38.8%) occurring on artificial turf, and 232 (61.2%) on natural grass. MANOVAs per 10 games indicated a significant playing surface effect by injury severity (F2,379 = 7.505; P = .001), primary type of injury (F12,379 = 4.412; P = .000), tissue type (F3,379 = 9.412; P = .000), elective imaging and surgical procedures (F3,379 = 3.517; P = .007), and turf age (F2,379 = 91.093; P = .000), but not by injury category (F3,379 = 2.175; P = .089), injury mechanism (F3,379 = 1.439; P = .133), or injury situation (F8,379 = 1.329; P = .181). Univariate analyses indicated significantly lower (P = .05 - .0001) IIRs across severity, both in 1st degree, 2.1 (95% CI, 1.8-2.5) vs 2.9 (2.5-3.2), and 2nd degree IIRs, 0.1 (95% CI, 0.1-0.2) vs 0.7 (0.5-0.9); defensive positions, 0.8 (95% CI, 0.6-1.1) vs 1.4 (1.2-1.7); contusions, 1.3 (95% CI, 1.1-1.6) vs 2.0 (1.7-2.3); muscle, 2.0 (95% CI, 1.7-2.3) vs 3.0 (2.6-3.4); MRI, 0.1 (95% CI, 0.0-0.2) vs 0.2 (0.1-0.4); and turf lasting 4-7 years, 0.8 (95% CI, 0.6-1.1) vs 0.9 (0.7-1.2), and 8+ years 0.1 (95% CI, 0.1-0.2) vs 0.5 (0.4-0.8) when comparing artificial turf vs natural grass, respectively. CONCLUSION: Since minimal differences existed between artificial turf and natural grass over an 8-year period of competitive play, artificial turf is a practical alternative when comparing thoracoabdominal injuries in collegiate football.