Achilles Tendon Trauma During NCAA Football Games On Artificial And Natural Grass Surfaces

Achilles tendon trauma poses a significant risk to an athlete’s career resulting in compromised sport performance potential and long-term quality-of-life issues. Although prior studies have resulted in equivocal LE findings when comparing artificial turf and natural grass, few studies have completed an extensive longitudinal comparison of Achilles tendon injuries between the two playing surfaces. PURPOSE: To quantify the incidence and etiology of Achilles tendon trauma during game-related college football on a heavyweight artificial turf versus a natural grass surface. METHODS: 41 universities volunteered to participate and were evaluated over 16 seasons (2006-21) across all NCAA Football Bowl Subdivision conferences. Outcomes of interest included injury grade, primary type of injury, injury category, injury situation and mechanism, player and skill position, imaging and surgical procedures, field and environmental conditions, and turf age. Tabular frequencies were determined and injury incidence rates [%; IIR, (95% CI)] were calculated using injuries per 10 games = [(number of injuries ÷ number of games) x 10]. RESULTS: Of the 2243 games documented, 1061 (47.3%) were played on a heavyweight artificial turf (≥9.0lbs/ft2) infill system, with 1182 games (52.7%) on natural grass. In sum, of 9360 total injuries, 41 [0.44%; 0.18, (0.14 - 0.25)] Achilles tendon injuries were recorded with 19 [46.3%; 0.18, (0.12 - 0.29)] occurring on artificial turf, and 22 [53.7%; 0.19, (0.12 - 0.28)] on natural grass. No significant surface effect was found across any outcome of interest (P > 0.05). Total cases were diagnosed most frequently as grade I [73.2%; 0.13, (0.09 - 0.19)], mostly tendon strains [48.9%; 0.09, (0.06 - 0.14)], occurring primarily to defensive players [56.1%; 0.10, (0.07 - 0.15)], and during rushing plays [34.1%; 0.06, (0.04 - 0.10)]. A total of six [14.6%; 0.03, (0.01 - 0.06)] tendon ruptures were documented, all requiring operative treatment. The non-significant differences observed between surfaces may be a function of small sample size. CONCLUSIONS: At this time, findings indicate that heavyweight turf is a viable alternative to natural grass. The results of this study, however, are generalizable only to this level of competition.