NCAA: Artificial Turf Can Increase Knee Injury Risk

A recent study, “Incidence of Knee Injuries on Artificial Turf Versus Natural Grass in National Collegiate Athletic Association American Football: 2004-2005 Through 2013-2014 Season” published on April 17, 2019 in the American Journal of Sports Medicine, examined whether the type of grass used in American football has an effect on knee injury rates. The researchers found that artificial turf was associated with a greater risk for certain types of knee injuries.

The study’s investigators collected data regarding anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), medial meniscus and lateral meniscal tear injuries which were captured in the NCAA Injury Surveillance System Men’s Football Injury and Exposure Data Sets. The researchers then compared injury rates which occurred on natural grass and those that occurred on artificial turf. They then filtered their results according to competition level (Divisions I, II and III) as well as overall.

Of the more than 3 million (3,009,205) athlete exposures and 2,460 knee injuries reported from 2004 to 2014 (1389 MCL, 522 ACL, 269 lateral meniscal, 164 media meniscal and 116 PCL), those that occurred on artificial turf had a little more than double the risk of PCL injury than those that occurred on natural grass (RR = 2.94; 95% CI, 1.61-5.68). Division I athletes who competed on artificial turf in particular experienced PCL injuries at 2.99 times the rate of those competing on natural grass (RR = 2.99; 95% CI, 1.39-6.99)

Athletes in the lower divisions that played on artificial grass had 1.63 times more a risk for ACL injury and 3.13 times the risk for PCL injuries than those who played on natural grass.

Drawing the data together into a conclusion, the investigators wrote that “Artificial turf is an important risk factor for specific knee ligament injuries in NCAA football. Injury rates for PCL tears were significantly increased during competitions played on artificial turf as compared with natural grass. Lower NCAA divisions (I and II) also showed higher rates of ACL injuries during the competitions on artificial turf vs. natural grass.”

Galvin J. Loughran, a Georgetown University School of Medicine student, who was one of the study co-authors said that the study also pointed to opportunities for further research. He told OTW, “Additional research needs to be done, particularly on how specific artificial playing surface types impact athletic injuries. Our study identifies an association between artificial playing surfaces in general and increased rates of specific knee injuries during college football games (PCL tears, and ACL tears in Divisions II & III). However, the database we analyzed did not provide information on specific artificial turf types, generations, or product lines so we were unable to determine if all types of artificial turf are associated with increased injury rates or if only some types of turf are associated with increased injury rates while other types are not.”

“Future studies looking at injury rates on different artificial turf generations and types would be useful to further characterize the effects of these surfaces and to determine what playing surface qualities are important for minimizing athletic injuries.”

Loughran and colleagues also added that this data can help orthopedic surgeons better advise their patients about the potential risks for playing on artificial turf. They added, “Orthopedic surgeons can counsel their patients about the growing body of evidence in the sports medicine literature that artificial playing surfaces are associated with an increased incidence of specific knee injuries in American football. Surgeons who feel they have higher risk patients may counsel them to be mindful of the surface they are playing on.”