Safety of third-generation artificial turf in male elite professional soccer players in Italian major league

Longitudinal analysis of the incidence rate of injury in elite youth football: Trends over six years including the COVID-19 pandemic period

OBJECTIVES

We aimed to analyze injury trends and the possible effects of the coronavirus disease (COVID-19) pandemic on the incidence rates of injury in young elite football players.

DESIGN

A prospective cohort study design was adopted.

PARTICIPANTS

Our study included 832 male football players who suffered an injury during any of the six competitive seasons.

SETTING

An elite youth football academy.

MAIN OUTCOME MEASURE

Descriptive data and the incidence of injury were calculated. A generalized linear mixed model was used to assess differences in the occurrence of injury among the various age groups. Joinpoint regression was used to analyze injury trends.

RESULTS

Joinpoint regression models showed a statistically significant decrease in the incidence of injury in all age groups with an average annual percent change (AAPC) of 13.9 (95 %Confidence Interval [CI]:-23.2 - 3.4) and -13.5 (95 %CI:-24.5 to -0.9) for models with zero and one joinpoint, respectively. Football players in older age groups sustain a higher number of injuries, probably due to a higher number of matches and greater training intensity.

CONCLUSION

This study showed a downward trend in injuries in the participants prior to the pandemic, with an evident increase in the incidence rate of injury during the COVID-19 pandemic.

Incidence of football injuries sustained on artificial turf compared to grass and other playing surfaces: a systematic review and meta-analysis

Background

Prior reviews have not conducted statistical synthesis of injury incidence on artificial turf in football. To analyse and compare the incidence of injuries sustained playing football (soccer) on artificial turf compared to grass and other playing surfaces.

Methods

This was a systematic review and meta-analysis. We searched PubMed, Scopus, SPORTDiscus, and Web of Science databases in October 2022 without filters. All observational studies (prospective or retrospective) that analysed injuries sustained playing football on artificial turf and which included a control group that played on grass or other surface were included. Studies were included if they reported the number of injuries and the exposure time for the playing surfaces. Risk of bias was assessed by Newcastle-Ottawa Scale. A random effects model was used to calculate the pooled incidence rate ratios (IRR) with 95% confidence intervals. Protocol was registered with PROSPERO on October 30th, 2022. Registration number: CRD42022371414.

Findings

We screened 1447 studies, and evaluated 67 full reports, and finally included 22 studies. Risk of bias was a notable issue, as only 5 of the 22 studies adjusted their analysis for potential confounders. Men (11 studies: IRR 0.82, CI 0.72-0.94) and women (5 studies: IRR 0.83, CI 0.76-0.91) had lower injury incidence on artificial turf. Professional players had a lower incidence of injury (8 studies: IRR 0.79, CI 0.70-0.90) on artificial turf, whereas there was no evidence of differences in the incidence of injury in amateur players (8 studies: IRR 0.91, CI 0.77-1.09). The incidence of pelvis/thigh (10 studies: IRR 0.72, CI 0.57-0.90), and knee injuries (14 studies: IRR 0.77, CI 0.64-0.92) were lower on artificial turf.

Interpretation

The overall incidence of football injuries is lower on artificial turf than on grass. Based on these findings, the risk of injury can't be used as an argument against artificial turf when considering the optimal playing surface for football.

Funding

No specific funding was received for this study.

Increased Risk of ACL Injury for Female but Not Male Soccer Players on Artificial Turf Versus Natural Grass: A Systematic Review and Meta-Analysis

Background:

Both natural grass (NG) and artificial turf (AT) are popular playing surfaces for soccer. Biomechanical studies have found increased frictional forces on AT that may lead to anterior cruciate ligament (ACL) injury. The increased risk of ACL injury during soccer in female participants may amplify this effect.

Purpose:

To systematically review the literature for studies comparing ACL injury risk in soccer players on AT versus NG and to specifically determine whether there were differences in injury risk in male versus female players when considering the playing surface.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three databases were searched for studies with evidence level 1 to 3 that compared the incidence of ACL injuries on AT versus NG in soccer players. Data recorded included study characteristics, sex, competition level, exposure setting (games or practices), turf type, and ACL injury information. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS) score, and incidence rate ratios (IRRs) were calculated.

Results:

Included were 7 articles (3 studying professional soccer, 3 collegiate soccer, 1 youth-level soccer; 4 male cohorts, 2 female cohorts, and 1 male and female cohort; mean MINORS score, 20 ± 0.8). Pooled ACL injury IRRs demonstrated no significant differences in overall ACL injury risk when playing soccer on AT compared with NG (IRR = 0.57 [95% CI, 0.21-1.53]; P = .31). A significantly increased risk of ACL injury in games played on AT compared with NG was detected for female (IRR = 1.18 [95% CI, 1.05-1.31]; P = .004) but not for male players (IRR = 1.18 [95% CI, 0.97-1.42]; P = .09). Subgroup analyses showed no significant differences in injury risk for games (IRR = 1.07 [95% CI, 0.97-1.18]; P = .20) or practices (IRR = 0.21 [95% CI, 0.04-1.23]; P = .09).

Conclusion:

Findings indicated that female soccer players had a significantly higher risk of ACL injury when playing games on AT versus NG, whereas no significant difference was seen in male players. No differences were found for the combined male/female cohort or for soccer games or training sessions played on AT compared with NG.

Athletic Play Surfaces and Injury Risk

ABSTRACT

Advancements in technology and the economic desires to maximize use of athletic playing surfaces have led to the development of various playing surfaces across the spectrum of sports. Each of these surfaces possesses specific safety profiles which are sport and population specific. Despite the growing medical literature on outdoor playing surfaces, inconsistent data exist on both orthopedic injuries and general medical concerns, such as surface component exposure toxicity and infection risk. Unfortunately, there is a paucity of data regarding various indoor playing surfaces and their effects on injury risk; this is an area ripe for further medical investigation. Understanding the differences in various play surfaces and their associated injury and health concerns is crucial for all medical staff providing care to athletes across the spectrum of skill and competition.

Novel Methodology for Football Rebound Test Method

Assessing and keeping control of the mechanical properties of sport surfaces is a relevant task in sports since it enables athletes to train and compete safely and under equal conditions. Currently, different tests are used for assessing athlete- and ball-surface interactions in artificial turf pitches. In order to make these evaluations more agile and accessible for every facility, it is important to develop new apparatus that enable to perform the tests in an easier and quicker way. The existing equipment for determining the vertical ball behavior requires a complex and non-easily transportable device in which the ball must be fixed to the upper part of the frame in a very precise position by means of a magnet. The rebound height is determined by capturing the acoustic signal produced when the ball bounces on the turf. When extended tests are conducted, the time required to evaluate a single field is too high due to the non-valid trials. This work proposes a novel methodology which allows to notoriously decrease the time of testing fields maintaining the repeatability and accuracy of the test method together with a compact device for improving its mobility and transport. Simulations and experiments demonstrates the repeatability and accuracy of the results obtained by the proposed device, which decreases the non-valid trials and notoriously reduces the time for field evaluation.

Injury Surveillance in Major League Soccer: A 4-Year Comparison of Injury on Natural Grass Versus Artificial Turf Field

BACKGROUND

Artificial playing surfaces are becoming more common due to decreased cost of maintenance and increased field usability across different environmental conditions. The Fédération Internationale de Football Association (FIFA) has approved newer generation artificial turf for soccer competition at the elite level, but many elite-level athletes prefer to play on natural grass surfaces due to a perceived increase in injury rate, discomfort, and fatigability on artificial turf.

HYPOTHESIS

Injury rates and rates of individually categorized types of injury experienced on artificial turf are noninferior to rates of injury on the standard comparator, natural grass, in elite-level Major League Soccer athletes.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Over the course of 4 Major League Soccer seasons (2013-2016), athlete injury data were recorded electronically. Injury data recorded in matches between 2 Major League Soccer teams were then analyzed. Playing surface was known for each venue, and all artificial turf surfaces were rated as 2-star according to FIFA criteria. Incidence rate ratios (Artificial Turf ÷ Natural Grass) were calculated with a 95% CI (α = .05) for both overall injury incidence and individual injury subgroups. A noninferiority margin (δ) of 0.15 was used to determine noninferiority of injury incidence rates.

RESULTS

A total of 2174 in-game injuries were recorded during the study period, with 1.54 injuries per game on artificial turf and 1.49 injuries per game on natural grass (incidence rate ratio, 1.033; 95% CI, 0.937-1.139). Within injury subgroups, overall ankle injury, Achilles injury, and ankle fracture were found to have a statistically higher incidence on artificial turf. Artificial turf was found to be noninferior to natural grass for overall foot injury and forefoot injury. No statistically significant differences were found in knee injuries between the 2 surfaces.

CONCLUSION

The overall rate of injury on artificial turf was noninferior to that on natural grass. Within individual injury categories, a higher rate of ankle injury was found on artificial turf. No other injury subgroup demonstrated statistically significant differences between surfaces.

CLINICAL RELEVANCE

FIFA 2-star rated artificial turf is a viable alternative to natural grass in elite-level soccer competition. Innovative research methods for comparing artificial turf versus natural grass may elucidate relative advantages with respect to player safety.

The effect of the change of football turf on knee kinematics of adolescent male football players

BACKGROUND

The aim of this study was to investigate the effect of the change of football turf on knee kinematics of adolescent male football players.

METHODS

Thirteen adolescent male football players were tested by a portable infrared motion analysis system based on markers. The angular displacements of flexion/extension,valgus/varus and internal/external rotation were calculated respectively when players performed 90° shuttle running on artificial turf and natural turf.

RESULTS

The maximum valgus angle and range of valgus/varus were larger when they were changed from artificial turf to natural turf (P<0.05). There were no significant differences in the maximum flexion angle, maximum extension angle, range of flexion/extension, maximum varus angle, maximum internal rotation angle, maximum external rotation angle and range of internal/external rotation (P>0.05).

CONCLUSIONS

The change of football turf has a significant effect on knee kinematics of adolescent male football players. The risk of noncontact anterior cruciate ligament (ACL) injury is increased when players who are changed from artificial turf to natural turf.

Perceived Links Between Playing Surfaces and Injury: a Worldwide Study of Elite Association Football Players

Background

Injuries in association football (soccer) are debilitating for players and can also be detrimental to the success of a team or club. The type or condition of a playing surface has been empirically linked to injuries, yet results are inconclusive. The overall purpose of this study was to analyse elite football players’ perceived links between playing surfaces and injury from a worldwide cohort of players. The results of this study can help to inform areas for future playing surface research aimed at trying to alleviate user concerns and meet user (i.e. the player) needs.

Methods

Quantitative data were collected from 1129 players across the globe to address the aim of this study.

Results

Ninety-one percent of players believed the type or condition of a surface could increase injury risk. Abrasive injuries, along with soreness and pain, were perceived to be greater on artificial turf. Surface type, surface properties and age were all potential risk factors identified by the players and linked to the playing surfaces.

Conclusions

The results identified three areas where future research should be focussed to help develop surfaces that alleviate user concerns and meet user (i.e. player) needs: (i) current reporting of soreness, pain or fatigue as injuries, (ii) contribution of surface properties to injury; and (iii) surface experience of players from different countries differentiates their views of injury risk.

Current Soccer Footwear, Its Role in Injuries and Potential for Improvement

Soccer is the most popular sport in the world and generates great financial revenue. It is also a sport whose practice has evolved considerably in terms of intensity and commitment, and in which the intrinsic risk of injury (not directly related to an interaction with the environment) is particularly high. In this context, the cleated shoe as a major component of soccer equipment may play a key role in the overexposure to injury. Soccer shoe evolution is all the more challenging, because design and mechanical structure differ in many points compared to other modern shoes developed for sports such as running, tennis and basketball. This critical review aims to elucidate the characteristics of modern soccer footwear and their possible link to soccer-specific injuries, focusing on the following areas: (1) ergonomics, comfort and proprioception; (2) shoe mechanical characteristics; (3) field surfaces and shoe design.

Switching between pitch surfaces: practical applications and future perspectives for soccer training

INTRODUCTION

Soccer training and completion is conventionally practiced on natural grass (NG) or artificial turf (AT). Recently, AT pitches for training/competition, and of unstable surfaces for injury prevention training has increased. Therefore, soccer players are frequently exposed to variations in pitch surface during either training or competition. These ground changes may impact physical and physiological responses, adaptations as well as the injury. The aim of this review was to summarize the acute physical and physiological responses, chronic adaptations, and injury risk associated with exercising on different pitch surfaces in soccer.

EVIDENCE ACQUISITION

Eligible studies were published in English, had pitch surface as an independent variable, and had physical, physiological or epidemiological information as outcome variables. Specific data extracted from the articles included the training response, training adaptations or injury outcomes according to different pitch surfaces. A total of 224 studies were retrieved from a literature search.

EVIDENCE SYNTHESIS

Twenty articles met the inclusion criteria: 9 for acute physical and physiological responses, 2 for training adaptations and 9 for injury assessment. The literature lacks consistent evidence regarding the effects of pitch surface on performance and health outcomes in soccer players. However, it seems that occasionally switching training surfaces seems a valuable strategy for focusing on specific musculoskeletal queries and enhancing players' fitness. For instance, sand training may be occasionally proposed as complementary training strategy, given the recruitment of additional musculature probably not involved on firmer surfaces, but the possible training-induced adaptations of non-conventional soccer surfaces (e.g., sand) might potentially result into a negative transfer on AT or NG.

CONCLUSIONS

Since the specific physical demands of soccer can differ between surfaces, coaches should resort to the use of non-traditional surfaces with parsimony, emphasizing the specific surface-related motor tasks, normally observed on natural grass or artificial turf. Further studies are required to better understand the physiological effects induced by systematic surface-specific training, or switching between pitch surfaces.

Neuromuscular responses and physiological patterns during a soccer simulation protocol. Artificial turf versus natural grass

BACKGROUND

Latest studies suggest similar performance of soccer players either on artificial turf (AT) or natural grass (NG). However, it is not clear if their muscular and physiological responses are also similar on both surfaces. This research aims to assess the influence of game surface on physiological patterns and neuromuscular responses of soccer players during a soccer simulation protocol (SSP) that incorporates repeated sprints and nonlinear actions at maximum speed.

METHODS

Sixteen amateur soccer players completed three bouts of the SSP on both AT and NG. The mechanical behaviour of both surfaces was recorded and the order was randomly established for each player. The physiological responses were measured during the SSP. A contra-movement jump and a tensiomyography analysis of the rectus femoris (RF) and biceps femoris (BF) were assessed right before and right after the SSP.

RESULTS

Both surfaces presented different mechanical properties. No differences among either surfaces or bouts were found for heart rate (HR) peak and HR mean (P>0.05). While the half-relaxation time of the RF on NG decreased after the SSP (right-leg: -44.430 ms; P=0.049; left-leg: -52.131 ms; P=0.008), the sustain time of the BF decreased after the SSP on AT (right-leg: +64.868 ms; P=0.007; left-leg: +87.564 ms; P<0.001). No differences between surfaces were found for the contra-movement jump.

CONCLUSIONS

The mechanical behaviour of both surfaces does not differ enough to cause different physiological and neuromuscular responses. Playing on AT should cause similar neuromuscular responses to NG.

Effect of Changes in Artificial Turf on Sports Injuries in Male University Soccer Players

Background:

Studies comparing the types and severity of trauma and injuries caused by different types of field surfaces have been conducted. However, there have been no studies on sports injuries caused by temporal deterioration of long-pile artificial turf fields and related decreases in the rubber chip and silica sand infill.

Purpose:

To investigate the influence of an artificial turf field on sports injuries in a university soccer team.

Study Design:

Descriptive epidemiological study.

Methods:

A total of 397 male soccer players who were members of a single university soccer team were surveyed over a 12-year period, from April 2003 to March 2015. During this period, the team played for 4 years on a soil field (2003-2006) and 8 years on artificial turf (2007-2014). We analyzed the effect of changes in the artificial turf on the incidence rate of sports injuries (injury rate per 1000 athlete-exposures). We calculated the incidence rate of injuries sustained by the team and compared the results for each year of the study.

Results:

After conversion of the field to artificial turf, there was a significant increase in the incidence of upper extremity trauma (P < .05). There was a significant increase in lower extremity sprains from 2007 to 2008, 1 year after the conversion from soil to artificial turf (P < .05). Analysis of the incidence of lower extremity muscle strain indicated that although the injury rate increased progressively, it decreased significantly after the insertion of additional rubber chips in 2014 (P < .05).

Conclusion:

After conversion to artificial turf, there was a significant increase in the incidence of upper extremity trauma. After the refurbishing with additional rubber chips, the incidence of lower extremity muscle strain significantly declined. When analyzing measures that could prevent sports injuries related to soccer, it is necessary to take into consideration the changes that occur to the artificial turf over time.

The influence of playing surface on injury risk in italian elite rugby players

BACKGROUND

There is a growing interest in the use of artificial turf surfaces in rugby. In particular, artificial surfaces may be an useful means of increasing participation in the sport by allowing greater usage of a given pitch, especially in regions where natural turf pitches are difficult to maintain.

METHODS

The incidence of site, nature, cause, and severity of training and match injuries was prospectively recorded in two professional teams (one equipped with World Rugby certified third generation artificial turf and the other with natural grass over the 2014-2015 season).

RESULTS

A total of 23,840 minutes of exposure was displayed for the whole sample, 1,440 minutes during matches and 22,400 during training sessions. We recorded 37 (48%) traumatic injuries and 39 (52%) overuse injuries. For traumatic injuries, we did not find significant differences in the overall risk injury between grass and artificial turf considering match exposure and training sessions. For overuse injuries, there were significant differences in the overall risk injury between grass and artificial turf considering match exposure (p=0.03) and training sessions (p=0.02).

CONCLUSION

In elite Italian rugby players, artificial turf seems to be safe in regards to traumatic injury while it seems to be a risk factor for overuse injuries.

LEVEL OF EVIDENCE

II.