Most literature finds more foot and ankle injuries on artificial turf

March 22, 2022

2 minute read


Gould HP, et al. Paper 68. Presented at the annual meeting of the American Academy of Orthopedic Surgeons; March 22-26, 2022; Chicago.

Gould reports no relevant financial information.

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CHICAGO — Athletes may have an increased rate of foot and ankle injuries when playing on artificial turf compared to natural grass, according to findings from a systematic review of the literature presented here.

“There may be an increase in the rate of foot and ankle injuries in all areas on artificial turf, and it takes all comers in all sports. We also found that there appeared to be an increase in overall injury and knee injury rates on artificial turf, for soccer specifically, but this did not apply to soccer and the other sports examined,” Heather P GouldMD, of Medstar Orthopedic Institute, said.

Gould and colleagues studied trends in lower extremity injury risk among athletes playing on artificial turf and natural grass playing surfaces, as shown in the published literature. According to the PRISMA guidelines, the researchers found 1,432 abstracts, of which 53 articles published from 1972 to 2020 met the study’s inclusion criteria. They excluded studies missing overall injury rates or lower extremity injury rates.

Heath P.Gould

Heather P Gould

For overall injuries, the researchers identified 32 articles, 17 of which showed no difference between artificial turf and natural turf. Twelve studies showed higher injury rates for turf and three reported higher injury rates for grass. Overall, 13 of 18 next-gen turf papers showed no difference in overall injury rates between playing surfaces. Additionally, five of nine papers that studied American football reported a injury rate higher on artificial turf, and 11 of the 17 items showed no difference in football. Three papers reported higher injury rates on turf, however, the studies were funded by the turf industry.

Of the 25 articles found on foot and ankle injuries, 12 showed higher injury rates on artificial turf, with 10 studies showing no difference. Three studies showed higher injury rates on natural turf, however, Gould said two of the studies received funding from the artificial turf industry. Additionally, researchers found that nine papers reviewing next-generation artificial turf reported a higher injury rate for turf.

Of the 32 papers found on knee injuries, 19 studies found no difference between surfaces, with eight showing a higher injury rate on artificial turf and five having a higher injury rate on natural turf. Overall, 14 of the 19 articles that reviewed Next Generation Turf reported no difference. Eight of 14 papers that examined American football reported higher injury rates on artificial turf, and 14 of 16 papers reported no difference in football player injury rates. Gould said he found no bias in the studies provided by the industry.

Of 13 articles found on hip injuries, 11 studies showed no difference between playing surfaces, and two showed higher injury rates on grass versus turf, although one article had been funded by the turf industry.

“We felt that many of the studies reporting higher injury rates on natural turf reported turf industry funding, so we have to be very smart as consumers of this literature in terms of how whose data we interpret so as not to extrapolate the wrong conclusions to our practice,” he said.

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