Document Title: Meyers-AJSM-Oct04.shtml
Article Title: Incidence, Causes, and Severity of High School Football Injuries on FieldTurf Versus Natural Grass: A 5-Year Prospective Study
Authors: Michael C. Meyers, PhD, FACSM, and Bill S. Barnhill, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: October 2004
Volume 32, pages 1626-1638
Keywords: synthetic, artificial playing surface, FieldTurf, AstroTurf, head, knee, injuries, adolescent, high school, football, injury prevention.

(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)

Comments: This study looks at injuries (with a particular focus on the knee and also head) in team sports played on a synthetic playing surface known as FieldTurf. The heavily advertised FieldTurf consists of infill layers of ground synthetic rubber underlain by sand, and held in place by friction resulting from HDPE fibres that have been combed erect by a special machine. The authors report a higher incidences of 0-day time loss injuries, noncontact injuries, surface/epidermal injuries, muscle-related trauma, and thermal-related injuries during games on FieldTurf. But there were more 1- to 2-day time-loss injuries, 22+ days time-loss injuries, head injuries, and ligament injuries on natural-grass games. So, while playing on FieldTurf does seem to translate into reduced ACL injuries, more MCL injuries appear. As with anything that is marketed as protective equipment, one must be cognizant of the revenge effect: that is, if the new equipment (in this case, not something that is worn but rather the playing surface itself) makes players feel safer, then they might take greater risks. The authors also note that the more consistent artificial composition enhances the speed of the game. But they don't directly note that kinetic energy increases with the square of speed...and that increased kinetic energy (as manifested during acceleration/deceleration and direction-changing manoeuvres) is what makes high-speed injuries exponentially worse than low-speed ones. (Additionally, higher speed translates into diminished reaction time.) The authors note that the higher ACL injury incidence on natural turf is likely attributable to the fact that in many places, natural grass is often allowed to dry out and become dormant, or is overseeded with more durable turf strains that sacrifice cushioning capability for toughness...and so the numbers of injuries on natural turf would probably be substantially lower if the grass were always vigorous and the soil were always moist. (Note that at least one of the authors has a conflict of interest, likely in the form of ownership in the FieldTurf Corporation. Note that there are competing products which use very similar infill-type cushioning arrangements, for example Sprinturf, Sportexe Momentum/Omnigrass, and Sportfield NT/Realgrass. It might be interesting to compare the properties of these different products, but given that they are all extremely similar in both design and construction, it is probably safe to say that the results would all be nearly identical. As a comparison standpoint, keep in mind that the old-fashioned product known as AstroTurf is basically an outdoor carpet with no infilling.)

ABSTRACT

Background: Numerous injuries have been attributed to playing on artificial turf. Recently, FieldTurf was developed to duplicate the playing characteristics of natural grass. No long-term study has been conducted comparing game-related, high school football injuries between the 2 playing surfaces.

Hypothesis: High school athletes would not experience any difference in the incidence, causes, and severity of game-related injuries between FieldTurf and natural grass.

Study Design: Prospective cohort study.

Methods: A total of 8 high schools were evaluated over 5 competitive seasons for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism, primary type of injury, grade and anatomical location of injury, type of tissue injured, head and knee trauma, and environmental factors.

Results: Findings per 10 team games indicated total injury incidence rates of 15.2 (95% confidence interval, 13.7–16.4) versus 13.9 (95% confidence interval, 11.9–15.6). Minor injury incidence rates of 12.1 (95% confidence interval, 10.5–13.6) versus 10.7 (95% confidence interval, 8.7–12.7), substantial injury incidence rates of 1.9 (95% confidence interval, 1.4–2.6) versus 1.3 (95% confidence interval, 0.8–2.1), and severe injury incidence rates of 1.1 (95% confidence interval, 0.7–1.7) versus 1.9 (95% confidence interval 1.2–2.8) were documented on FieldTurf versus natural grass, respectively. Multivariate analyses indicated significant playing surface effects by injury time loss, injury mechanism, anatomical location of injury, and type of tissue injured. Higher incidences of 0-day time loss injuries, noncontact injuries, surface/epidermal injuries, muscle-related trauma, and injuries during higher temperatures were reported on FieldTurf. Higher incidences of 1- to 2-day time loss injuries, 22+ days time loss injuries, head and neural trauma, and ligament injuries were reported on natural grass.

Conclusions: Although similarities existed between FieldTurf and natural grass over a 5-year period of competitive play, both surfaces also exhibited unique injury patterns that warrant further investigation.

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