Abstract
Objectives:
With increasing concerns of rising medical costs, the potential for long-term articular changes, and the perceived higher incidence of injury while playing on artificial turf, no long term studies have specifically compared elective medical procedures following injury from competitive play on artificial and natural grass surfaces. Therefore, this study quantified elective imaging and surgery following surface-related college football game trauma on artificial and natural grass fields.
Methods:
39 universities were evaluated over 15 competitive seasons (2006-2020) across all Football Bowl Subdivision (FBS) conferences. Playing surfaces were divided into two groups based on a heavyweight, artificial turf infill system (≥9.0 lbs infill/ft2) and natural grass. Outcomes of interest included elective imaging and surgery across injury category, primary type of injury, anatomical location, and specific procedures. Data were subject to multivariate analyses of variance (MANOVA) and Wilks’ λ criteria using GLM procedures, and expressed as elective imaging and surgical incidence rates (lR) per 10 game season.
Results:
Of the 2,215 games documented, 1,097 games (49.5%) were played on a 3-layer artificial turf (≥9.0 lbs/ft2) infill system versus 1,118 games (50.5%) played on natural grass. In sum, of the 9,137 total injuries reported, 4,010 were surface-related cases, with 1,757 injuries reported on artificial turf and 2,253 on natural grass, totaling 1,081 player-to-surface impacts, 2,429 shoe:surface injuries during physical contact, and 500 shoe:surface during noncontact cases. Surface-related trauma on artificial turf resulted in 773 elective imaging and 231 surgical procedures, with 965 imaging and 308 surgeries ordered following injuries on natural grass. MANOVA indicated significant main effects by elective imaging (F2,1738 = 4.718; P = .009) and surgical procedure (F1,539 = 5.974; P = .003) between surfaces. Post hoc analyses indicated a significantly lower (P < .05) incidence of radiographs [4.1, (95% CI, 3.8-4.4) vs 4.7 (4.4-5.0)], MRIs [2.8, (95% CI, 2.6-3.1) vs 3.6 (3.4-3.9)] and elective imaging procedures combined [7.1, (95% CI, 6.8-7.3) vs 8.6 (8.4-8.8)] following trauma on heavyweight artificial turf fields versus natural grass, respectively. A significantly lower (P < .05) incidence of imaging procedures were ordered on player-to-surface impact trauma [1.5, (95% CI, 1.3-1.8) vs 2.1 (1.9-2.4)], shoe:surface trauma during physical contact [4.4, (95% CI, 4.1-4.7) vs 5.2 (4.9-5.5)], foot injuries [0.6, (95% CI, 0.5-0.7) vs 1.1 (0.9-1.2)], contusions [0.4, (95% CI, 0.3-0.6) vs 0.9 (0.7-1.1)], ligament sprains/tears [4.6, (95% CI, 4.3-4.9) vs 5.3 (5.0-5.6)], and muscle strains/tears [0.2, (95% CI, 0.2-0.3) vs 0.7 (0.6-0.9)] following injury on heavyweight artificial turf when compared to natural grass fields, respectively. Post hoc analyses indicated a significantly lower (P < .05) incidence of total surgeries [2.1, (95% CI, 1.9-2.4) vs 2.8 (2.5-3.0)], surgeries following shoe:surface trauma during physical contact [1.1, (95% CI, 0.9-1.3) vs 1.6 (1.4-1.8)], and surgeries as a result of ligament tears [1.0, (95% CI, 0.9-1.2) vs 1.5 (1.3-1.7)] following competitive play on heavyweight artificial turf when compared to natural grass fields, respectively. Surgical procedures involving artificial turf injuries required single tissue arthroscopic repair (n=92; 40%), multiple tissue reconstructive repair (n=90; 39%), and ORIF (n=49; 21%), whereas (n=152, 49%) of natural grass trauma involved single tissue arthroscopic repair, followed by multiple tissue reconstructive repair (n=94; 31%) and ORIF (n=62; 20%).
Conclusions:
The significantly lower incidence of elective imaging and surgical procedures following competitive play on heavyweight artificial turf surfaces translates to lower health care costs from less severe trauma than observed on natural grass surfaces. This is the first longitudinal study that directly compares and addresses elective medical procedures as they relate specifically to football injury. The findings of this study, however, may be generalizable only to this level of football competition.