Risk of Anterior Cruciate Ligament Injury in Athletes on Synthetic Playing Surfaces: A Systematic Review
Balazs GC, Pavey GJ, Brelin AM, Pickett A, Keblish DJ, Rue JP
The American journal of sports medicine · 37 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Systematic review (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2014-08-27 · Am J Sports Med · vol. 43 · issue 7 · pp. 1798–1804
- Publisher
- SAGE Publishing
- Cited
- 64 citations · more than 95% of similar papers · 4.5× the field average
- Impact
- Top 10% most cited in its field
- References
- 35 works
- Access
- Paywalled
- Research areas
- Knee injuries and reconstruction techniques · Sports injuries and prevention · Shoulder Injury and Treatment
- Keywords
- Anterior cruciate ligament, Athletes, ACL injury, Medicine, Football, Systematic review, Cochrane Library, American football, Physical therapy, Relative risk, Inclusion and exclusion criteria, Meta-analysis, Injury prevention, Anterior Cruciate Ligament Injuries, Poison control, MEDLINE, Surgery, Internal medicine, Emergency medicine, Confidence interval, Alternative medicine, Geography, Pathology
- MeSH
- humans, knee injuries, risk factors, football, soccer, athletes, anterior cruciate ligament injuries
6 authors
From US
- George C. Balazs · correspondingWalter Reed National Military Medical Center
- Gabriel J. PaveyWalter Reed National Military Medical Center
- Alaina M. BrelinWalter Reed National Military Medical Center
- Adam M. PickettWalter Reed National Military Medical Center
- David KeblishUnited States Naval Academy
- John-Paul H. RueUnited States Naval Academy
Abstract
Background
The effect of synthetic playing surfaces on the risk of injury in athletes is frequently debated in the orthopaedic literature. Biomechanical studies have identified increased frictional force at the shoe-surface interface, theoretically increasing the risk of injury relative to natural grass. This increase in frictional force is potentially relevant for the risk of anterior cruciate ligament (ACL) rupture, where noncontact mechanisms are frequent. However, clinical studies examining this issue have shown mixed results.
Hypothesis/purpose
The purpose of this study was to systematically review the available literature on risk of ACL rupture on natural grass versus artificial turf. We hypothesized that the risk of ACL rupture on synthetic playing surfaces would not be higher than that of natural grass playing surfaces.
Study design
Systematic review.
Methods
A systematic keyword search was performed of OVID, EMBASE, the Cochrane Library of Systematic Reviews, and the PROSPERO International Prospective Register of Systematic Reviews. Candidate articles were included if they reported the risk ratio of ACL rupture on natural grass versus synthetic playing surfaces, were of level 3 evidence or better, and included only ACL injuries sustained during organized athletic events. Exclusion criteria included a study with non-field-related sports and the use of historical cohorts for calculating risk ratios.
Results
A total of 10 studies with 963 ACL injuries met criteria for inclusion, all of which reported on soccer and football cohorts. Among these, 4 studies (753 ACL injuries) found an increased risk of ACL injury on artificial playing surfaces. All 4 of these articles were conducted using American football cohorts, and they included both earlier-generation surfaces (AstroTurf) and modern, 3rd-generation surfaces. Only 1 study in football players found a reduced risk of ACL injury on synthetic playing surfaces. No soccer cohort found an increased risk of ACL injury on synthetic surfaces.
Conclusion
High-quality studies support an increased rate of ACL injury on synthetic playing surfaces in football, but there is no apparent increased risk in soccer. Further study is needed to clarify the reason for this apparent discrepancy.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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