ACL Injuries More Likely on Artificial Turf Than Natural Turf

Anterior cruciate ligament (ACL) injuries were more likely to happen on artificial turf than natural turf according to a new study.

The study, “Epidemiological Comparison of ACL Injuries on Different Playing Surfaces In High School Football and Soccer,” was published on May 5, 2022, in Orthopaedic Journal of Sports Medicine.

“Anterior cruciate ligament injuries are among the most common serious injuries to athletes in the United States. Among high school sports, the highest rates of ACL injury occur in soccer and football,” the researchers wrote.

In their study, the researchers compared ACL injuries on artificial turf versus natural grass using a nationally representative sample of high school athletes participating in football and boys’ and girls’ soccer.

They collected data on ACL injuries through the High School Reporting Information Online surveillance system during the 2007-08 through 2018-19 school years.

Overall, 1,039 ACL injuries were reported, which, if extrapolated to the overall national population, could represent as many as 389,320 (95% CI, 358,010-420,630) injuries. The researchers found that 74,620 estimated football-related ACL injuries occurred on artificial turf and 122,654 on natural grass.

In soccer, 71,877 ACL injuries occurred on artificial turf compared with 104,028 on natural grass. The injuries were contact-related for 50.2% of football-related ACL injuries on artificial turf and 60.8% on natural grass. In soccer, a noncontact mechanism was more dominant on both artificial turf (61.5%) and natural grass (66.4%).

Among all injuries, ACL injuries were more likely to occur on artificial turf than natural grass in both football and girls’ soccer; however, there was no significant association found in boys’ soccer.

Among lower extremity injuries, ACL injuries were more likely to occur on artificial turf than natural grass in both boys’ and girls’ soccer, but the association was significant in football.

“ACL injuries were more likely to occur on artificial turf than natural grass; however, this relationship was not statistically significant for all sports,” the researchers wrote.

Study authors included Micah S. Ngatuvai, M.B.A., Jingzhen Yang, Ph.D., MPH, Sandhya Kistamgari, MPH, Gary A Smith, M.D., DrPH, all of the Abigail Wexner Research Institute at Nationwide Children’s Hospital in Columbus, Ohio. Christy L. Collins, Ph.D., of Datalys Center for Sports Injury Research and Prevention in Indianapolis also contributed to the study.