Context: Synthetic turf has become an increasingly common playing surface for athletics and has changed dramatically since its introduction more than 50 years ago. Along with changes to surface design, maintenance needs and recommendations have become more standardized and attentive both to upkeep and player-level factors. In particular, synthetic turf maintenance as it relates to athlete health and safety is an important consideration at all levels of play.
Evidence Acquisition: A literature search of MEDLINE and PubMed for publications between the years 1990 and 2018 was conducted. Keywords included synthetic turf, artificial turf, field turf, and playing surface. Additionally, expert opinion through systematic interviews and practical implementation were obtained on synthetic turf design and maintenance practices in the National Football League.
Study Design: Clinical review.
Level of Evidence: Level 5.
Results: Synthetic turf has changed considerably since its inception. Playing surface is a critical component of the athletic environment, playing a role both in performance and in athlete safety. There are several important structural considerations of third-generation synthetic turf systems currently used in the United States that rely heavily on strong and consistent maintenance. A common misconception is that synthetic turf is maintenance free; in fact, however, these surfaces require routine maintenance. Whether athletes experience more injuries on synthetic over natural surfaces is also of interest among various levels and types of sport.
Conclusion: Modern synthetic turf is far different than when originally introduced. It requires routine maintenance, even at the level of local athletics. It is important for sports medicine personnel to be familiar with playing surface issues as they are often treating athletes at the time of injury and should maintain a level of awareness of contemporary research and practices regarding the relationships between synthetic turf and injury.
|2012||Hershman EB, Anderson R, Bergfeld JA, Bradley JP, Coughlin MJ, Johnson RJ, Spindler KP, Wojtys E, Powell JW. An analysis of specific lower extremity injury rates on grass and FieldTrf playing surfaces in National Football League games: 2000-2009 seasons. Am J Sports Med. October 2012;40(10):2200-2205.|
|2017||Jastifer J, Kent R, Crandall J, Sherwood C, Lessley D, McCullough KA, Coughlin MJ, Anderson RB. The athletic shoe in football: apparel or protective equipment? Sports Health. March–April 2017;9(2):126-131.|
|1992||Powell JW, Schootman M. A multivariate risk analysis of selected playing surfaces in the National Football League: 1980 to 1989. Am J Sports Med. 1992;20(6):686-694.|
|2014||George E, Harris AHS, Dragoo JL, Hunt KJ. Incidence and risk factors for turf toe injuries in intercollegiate football: data from the National Collegiate Athletic Association injury surveillance system. Foot Ankle Int. February 2014;35(2):108-115.|
|2010||Drakos MC, Hillstrom H, Voos JE, Miller AN, Kraszewski AP, Wickiewicz TL, Warren RF, Allen AA, O'Brien SJ. The effect of the shoe-surface interface in the development of anterior cruciate ligament strain. J Biomech Eng. January 2010;132(1):011003.|
|1990||Skovron ML, Levy IM, Agel J. Living with artificial grass: a knowledge update, II: epidemiology. Am J Sports Med. September 1990;18(5):510-513.|
|2010||Meyers MC. Incidence, mechanisms, and severity of game-related college football injuries on FieldTurf versus natural grass: a 3-year prospective study. Am J Sports Med. April 2010;38(4):687-697.|
|2015||Lievers WB, Adamic PF. Incidence and severity of foot and ankle injuries in men’s collegiate American football. Orthop J Sports Med. 2015;3(5):2325967115581593.|
|2013||Dragoo JL, Braun HJ, Harris AHS. 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.|
|2004||Meyers MC, Barnhill BS. Incidence, causes, and severity of high school football injuries on FieldTurf versus natural grass: a 5-year prospective study. Am J Sports Med. 2004;32(7):1626-1638.|
|2000||Guskiewicz KM, Weaver NL, Padua DA, Garrett WE Jr. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. September 2000;28(5):643-650.|
|2007||Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train. October–December 2007;42(4):495-503.|
|2011||Williams S, Hume PA, Kara S. A review of football injuries on third and fourth generation artificial turfs compared with natural turf. Sports Med. November 2011;41(11):903-923.|
|1996||Lambson RB, Barnhill BS, Higgins RW. Football cleat design and its effect on anterior cruciate ligament injuries: a three-year prospective study. Am J Sports Med. 1996;24(2):155-159.|
|2013||Hunt KJ, George E, Harris AHS, Dragoo JL. Epidemiology of syndesmosis injuries in intercollegiate football: incidence and risk factors from National Collegiate Athletic Association injury surveillance system data from 2004-2005 to 2008-2009. Clin J Sport Med. 2013;23(4):278-282.|
|2020||Mack CD, Kent RW, Coughlin MJ, Shiue KY, Weiss LJ, Jastifer JR, Wojtys EM, Anderson RB; NFL Musculoskeletal Committee. Incidence of lower extremity injury in the National Football League: 2015 to 2018. Am J Sports Med. July 2020;48(9):2287-2294.|
|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.|