Incidence, Mechanisms, and Severity of Game-Related High School Football Injuries Across Artificial Turf Systems of Various Infill Weights

Abstract

Background: Artificial turf surfaces are developed to duplicate playing characteristics of natural grass. With the newer generations of sand and rubber infill systems, the infill is a common component that varies between fields and is a critical factor that could influence the player-surface interaction. Because the influence of infill weight on sport trauma is unknown, this study quantified football trauma in high schools in the United States across artificial turf systems of various infill weights. Hypothesis: Athletes would not experience differences in game-related injuries across artificial turf systems of various infill weights. Study Design: Cohort study; Level of evidence, 2. Methods: Artificial turf systems were divided into 4 sand/rubber infill weight groups by pounds per square foot: ≥9.0, 6.0-8.9, 3.0-5.9, and 0.0-2.9. A total of 57 high schools in 4 states participated over the course of 5 seasons. Outcomes of interest included injury severity, as a function of infill weight, across head, knee, and shoulder traumas; injury category; primary type of injury; tissue type; specific body location of injury; cleat design; environmental factors; and turf age. Data were subject to multivariate analyses of variance (MANOVAs) and Wilks λ criteria through use of general linear model procedures. Results: Of 1837 games documented, 528 games were played on infill weights of ≥9.0 lb/ft2, 521 on 6.0-8.9 lb/ft2, 525 on 3.0-5.9 lb/ft2, and 263 on 0.0-2.9 lb/ft2, with 4655 total injuries reported. MANOVAs indicated significant infill weight effects across injury severity (F2,4648 = 5.087; P =.0001), with significant main effects also observed by injury category, tissue injured, lower extremity joint and muscle, cleat design, environmental factors, and turf age. Post hoc analyses indicated significantly lower (P