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

OBJECTIVES: Today's new generations of artificial turf are increasingly being installed to duplicate or exceed playing characteristics of natural grass. Rather than playing on the polyethylene turf fibers, shoe:surface interaction actually occurs between the cleat and the various proprietary sand/rubber infill composites of varying weight. At this time, the influence of surface infill weight on football trauma is unknown. The purpose of this study was to quantify incidence, mechanisms, and severity of game-related high school football trauma across artificial turf systems of various infill weight. METHODS: Artificial turf systems were divided into four sand/rubber infill weight groups based on lbs per square foot: (A) > 9.0, (B) 6.0 - 8.9, (C) 3.0 - 5.9 and, (D) 0.0 - 3.0. A total of 43 high schools participating across four states over 3 competitive seasons were evaluated for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism and situation, primary type of injury, injury grade and anatomical location, field location at time of injury, injury severity, head, shoulder, and lower extremity trauma, cleat design, turf age, and environmental factors. RESULTS: Of the 847 high school games documented, 301 games (35.5%) were played on infill (A), 231 (27.3%) on infill (B), 189 (22.3%) on infill (C), and 126 (14.9%) on infill (D). A total of 1,979 injuries were documented, with significantly lower total injury incidence rates (IIR), [18.8 (95% CI, 18.3-19.1) vs 23.3 (22.4-24.0) vs 31.6 (30.5-32.2) and 22.1 (20.8-22.9)], substantial IIRs [3.9 (95% CI, 3.4-4.5) vs 4.8 (4.1-5.4), 7.7 (7.1-8.3) and 6.1 (5.2-5.9)], trauma from player-to-player collisions [8.7 (95% CI, 8.2-9.0) vs 11.0 (10.5-11.5), 16.4 (15.5-17.1) and 9.8 (9.4-10.0)], playing surface impact trauma [2.6 (95% CI, 2.1-3.1) vs 4.2 (3.6-4.8), 5.6 (4.8-6.2) and 4.4 (13.5-5.2)], and less muscle trauma [6.1 (95% CI, 5.5-6.6) vs 9.7 (9.4-9.9), 13.7 (12.8-24.4 and 8.7 (8.0-9.2)], while competing on infill weighing >9.0 (A) versus 6.0 -8.9 (B), 3.0 - 5.9 (C), and 0.0-3.0 (D), respectively. Significantly lower trauma (P < .05) was also observed across concussions, muscle-tendon overload, time loss, skill positions, injury mechanism and situation, lower and upper extremity joints, adverse weather conditions, and turf age while competing on infill (A) when compared to infill (C). CONCLUSION: As the artificial infill surface weight decreased, the incidence of game-elated high school football trauma significantly increased across numerous playing conditions. This is the first study to investigate the influence of artificial infill surface weight on the incidence of game-related high school football trauma. Since this study is in the early stages, initial findings warrant further investigation.