Soccer on Turf vs Grass: Is there Similar Injury Risk?

September 8th, 2020

Injury Surveillance in Major League Soccer: A 4-Year Comparison of Injury on Natural Grass Versus Artificial Turf Field
Source: The American Journal of Sports Medicine, first published July 15, 2019

Clinical Question: Are injury rates and rates of individually categorized types of injury experienced on artificial turf and natural grass similar in elite-level Major League Soccer athletes?

Bottom Line: The overall rate of injury on artificial turf was noninferior to that on natural grass. A total of with 1.54 injuries per game on artificial turf and 1.49 injuries per game on natural grass. 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 non-inferior to natural grass for overall foot injury and forefoot (ex. turf toe) injury. No statistically significant differences were found in knee injuries between the 2 surfaces.

Points to Consider: 2174 in-game injuries were recorded over the course of 4 Major League Soccer seasons (2013-2016). A non-inferiority margin (δ) of 0.15 was used to determine non-inferiority of injury incidence rates.

Takeaway: FIFA 2-star rated artificial turf is a viable alternative to natural grass in elite-level soccer competition.

About the Author:
Catherine A. Logan, MD, MBA, MSPT is a sports medicine Orthopaedic Surgeon and writer. Based in Denver, CO, she is an attending at Colorado Sports Medicine & Orthopaedics at Rose Medical Center. Dr. Logan is the Head League Physician for Premier Lacrosse League (PLL) member of the team physician pool for the US Ski & Snowboard teams each year. Dr. Logan completed her Orthopaedic Surgery residency at the Harvard Combined Orthopaedic Residency Program and her Sports Medicine Fellowship training at the prestigious Steadman Philippon Research Institute/The Steadman Clinic in Vail, CO. Logan is also on the board of The Chill Foundation.