Lower Extremity Injury Rates on Artificial Turf Versus Natural Grass Playing Surfaces: A Systematic Review.

Area of Science:

• Sports Medicine
• Biomechanics
• Epidemiology

Background:

• No comprehensive systematic review has previously compared sports injuries on artificial turf versus natural grass.
• Understanding injury risks associated with different playing surfaces is crucial for athlete safety.

Purpose of the Study:

• To systematically review and examine the risk of overall and lower extremity injuries across all sports and competition levels.
• To differentiate injury risks between old-generation and new-generation artificial turf compared to natural grass.

Main Methods:

• Systematic review of English-language literature following PRISMA guidelines.
• Inclusion of studies comparing injury rates (overall, hip, knee, foot/ankle) on artificial turf and natural grass.
• Exclusion of studies not reporting on overall or lower extremity injury rates; no meta-analysis due to heterogeneity.

Main Results:

• 53 articles (1972-2020) were reviewed.
• Most studies found similar overall injury rates on new-generation artificial turf versus natural grass.
• Higher foot and ankle injury rates were reported on both old and new artificial turf compared to natural grass.
• Knee and hip injury rates were similar for soccer players on new turf, but football players had higher knee injury rates on artificial turf.

Conclusions:

• Artificial turf is linked to a higher incidence of foot and ankle injuries compared to natural grass.
• Knee and hip injury rates are generally comparable between surfaces, with a potential increased risk for elite football players on artificial turf.
• Industry-funded studies were more likely to report higher overall injury rates on natural grass.