Increased Risk of ACL Injury for Female but Not Male Soccer Players on Artificial Turf Versus Natural Grass: A Systematic Review and Meta-Analysis
Xiao M, Lemos JL, Hwang CE, Sherman SL, Safran MR, Abrams GD
Orthopaedic journal of sports medicine · 21 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
- Meta-analysis (classified by our AI screen)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Possibly industry funded
- Authors
- At least one author declares a financial tie to industry
Based on full-text disclosure statement.
Publication
- Published
- 2022-08-01 · Orthop J Sports Med · vol. 10 · issue 8 · p. 23259671221114353
- Publisher
- SAGE Publishing
- Cited
- 29 citations · more than 81% of similar papers · 1.6× the field average
- References
- 51 works
- Access
- Open access (journal) · CC-BY-NC-ND
- Research areas
- Sports injuries and prevention · Turfgrass Adaptation and Management · Exercise and Physiological Responses
- Keywords
- Anterior cruciate ligament, ACL injury, Medicine, Meta-analysis, Physical therapy, Systematic review, Cohort study, Injury prevention, Incidence (geometry), Poison control, MEDLINE, Surgery, Emergency medicine, Internal medicine
6 authors
From US
- Michelle X. Xiao · correspondingStanford University
- Jacie L. LemosStanford University
- Calvin Eric HwangStanford University
- Seth Lawrence ShermanStanford University
- Marc Raymond SafranStanford University
- Geoffrey D. AbramsStanford University
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.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC-ND).
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