The effect of playing surface on the incidence of ACL injuries in National Collegiate Athletic Association American football

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Dragoo, Jason L.¹; Braun, Hillary J.¹; Harris, Alex H. S.¹

The effect of playing surface on the incidence of ACL injuries in National Collegiate Athletic Association American football

Knee. June 2013;20(3):191-195

©2012 Elsevier B.V. All rights reserved.

Affiliations

¹Department of Orthopaedic Surgery, Stanford University, Palo Alto, CA, USA
Abstract and keywords

Background: Artificial playing surfaces are widely used for American football practice and competition and anterior cruciate ligament (ACL) injuries are common. This study analyzed the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) men's football ACL injury database from 2004–2005 through 2008–2009 to determine the effect of playing surface on ACL injury in NCAA footballathletes.

Methods: This database was reviewed from the 2004–2005 through 2008–2009 seasons using the specific injury code, “Anterior cruciate ligament (ACL) complete tear.” The injury rate was computed for competition and practice exposures. Ninety-five percent confidence intervals were calculated using assumptions of a Poisson distribution. Pair-wise, two-sample tests of equality of proportions with a continuity correction were used to estimate the associations of risk factors.

Results: There was an incidence rate of 1.73 ACL injuries per 10,000 athlete-exposures (A-Es) (95% CI 1.47–2.0) on artificial playing surfaces compared with a rate of 1.24 per 10,000 A-Es (1.05–1.45, p < 0.001) on natural grass. The rate of ACL injury on artificial surfaces is 1.39 times higher than the injury rate on grass surfaces. Non-contact injuries occurred more frequently on artificial turf surfaces (44.29%) than on natural grass (36.12%).

Conclusions: NCAA football players experience a greater number of ACL injuries when playing on artificial surfaces.

Keywords: Playing surface; Artificial turf; Anterior cruciate ligament; Injury; American football; ACL; Grass
Links

DOI: 10.1016/j.knee.2012.07.006

PubMed: 22920310

WoS: 000319533700010
History

Received: 2012-04-04

Revised: 2012-06-14

Accepted: 2012-07-08

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2017	Hunt KJ, Hurwit D, Robell K, Gatewood C, Botser IB, Matheson G. Incidence and epidemiology of foot and ankle injuries in elite collegiate athletes. Am J Sports Med. February 2017;45(2):426-433.
2019	Mack CD, Hershman EB, Anderson RB, Coughlin MJ, McNitt AS, Sendor RR, Kent RW. Higher rates of lower extremity injury on synthetic turf compared with natural turf among National Football League athletes: epidemiologic confirmation of a biomechanical hypothesis. Am J Sports Med. January 2019;47(1):189-196.
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2021	Kent R, Yoder J, O'Cain CM, Meade Spratley E, Arbogast KB, Sorochan J, McNitt A, Serensits T. Force-limiting and the mechanical response of natural turfgrass used in the National Football League: a step toward the elimination of differential lower limb injury risk on synthetic turf. J Biomech. October 11, 2021;127:110670.
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