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

Abstract

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.

Two-Dimensional and Three-Dimensional Biomechanical Factors During 90° Change of Direction are Associated to Non-Contact ACL injury in Female Soccer Players

“…The rapid growth of women's football (soccer) participation is bringing about increasing rates and earlier occurrence of primary Anterior Cruciate Ligament (ACL) injury. 1,2 Several authors have demonstrated that female footballers are at overall higher risk of ACL injury than their male counterparts 1,3,4 and are less responsive to targeted preventative interventions e.g., the FIFA 11+ program. 1,5,6 Therefore, a deeper comprehension of modifiable risk factors, such as ACL injury biomechanics, has been advocated to mitigate the injury risk in female football academies.…”

Evaluation of blood metal levels of hockey teams after playing on synthetic turf fields

“…While the first field of study is examining the toxic substances contained in artificial turf fields, (1,2,(4)(5)(6)(7)(8)(9) the other field of study is examining the effects of artificial turf fields on sports injuries. (10)(11)(12)(13)(14)(15)(16) In a study on metals that included mercury (Hg), arsenic (As), lead (Pb), zinc (Zn), aluminum (Al), iron (Fe), and magnesium (Mg) in samples taken from 32 different synthetic fields, a total of 25 metals were examined and it has been reported that Mg, Fe and Zn levels were significantly higher than those of the other metals. (8) In addition, in studies on crumb rubber, it has been reported that while tire rubber contains high levels of Zn, it also contains Fe and Mg, albeit at low levels.…”

Jumps and Lower Limb Strength Asymmetry in Young Soccer Players: Differences Between Sand and Conventional Surfaces

“…The increasing diffusion of sports disciplines very similar to football (futsal and beach soccer in the first instance) and the spread of playing surfaces of different nature (artificial vs. natural, artificial of different and latest generation) have highlighted the need to investigate the role that these play in the realisation of the performance (Gould et al, 2023;López-Fernández et al, 2018;Williams et al, 2011), load and skills associated with the sport (Strutzenberger et al, 2022;Kuitunen et al, 2023;Xiao et al, 2022).…”