1046 - Lower Extremity Injury Rates on Turf Versus Natural Grass Surfaces - An Analysis of Professional Football Athletes

Objectives: The purpose of this study was to quantify the rate of lower extremity injuries occurring in NFL players on artificial turf compared to natural grass surfaces and to characterize the degree of time missed with injury and proportion of injuries requiring surgery.

Design: Lower extremity injury data for the 2021 and 2022 NFL seasons was obtained using public available records from the internet. Data collected included player position and age, playing surface of field on which injury occurred, injury type, weeks missed with injury, and whether patient underwent season-ending or minor surgery. Multivariable logistic regression was performed to determine the influence of field type on risk of major surgery.

Results: Combining the 2021/2022 seasons, the incidence rate of lower extremity injury on natural grass surfaces was 1.22 injuries/game while for turf surfaces, the incidence rate was 1.42 injuries/game. Injury severity was stratified by weeks missed, as illustrated in figure 1. Odds of season-ending surgery was found to significantly higher on turf surfaces compared to natural grass surfaces (OR 1.60, 95% CI 1.28-1.99), while additional variables, including weather, age, position, and week of injury occurrence and history of prior injury were not found to influence the odds of season-ending surgery.

Conclusions: Our analysis of the 2021 and 2022 NFL seasons demonstrates a higher incidence rate of injuries on artificial turf surfaces compared to natural grass surfaces. In addition, the odds of more serious injury requiring season-ending surgery was found to be significantly higher on artificial turf compared to natural grass. This study suggests that risk of injury, particularly serious lower extremity requiring surgical intervention, is elevated on artificial playing surfaces. Additional research is needed in this topic prior to more widespread adoption of turf surfaces in all age groups of football, from professional to youth age football.