Laird Harrison

March 14, 2014

NEW ORLEANS — Professional soccer players suffer an equal number of injuries whether they play on natural grass or artificial turf, a new study shows.

"The feeling of players is that they have more injuries with artificial turf," said lead investigator Alessandro Ciompi, MD, an orthopedic surgeon at the University of Rome. "We were surprised because we did not see any difference."

The technology of artificial turf has improved since the early days, when a study showed that it increased the risk for injury among soccer players, Dr. Ciompi told Medscape Medical News (Scand J Med Sci Sports. 1996;6:40-45). Current third-generation turf fields are safer because they feature infill made from coconut fiber, which helps retain moisture and lowers the temperature of the field.

Few studies have compared fields in similar climatic conditions, and a debate over the merits of artificial and natural surfaces rages on.

To add some light to the heat, Dr. Ciompi and his team followed 4 first-division Italian professional soccer teams in the 2011/12 season. The home fields of the Cesena and Novara teams were made of artificial turf, and the home fields of the Torino and Juventus teams were made of natural grass.

The researchers tabulated acute injuries suffered by players on the 4 teams during the 36 games played on each type of surface. Games played in the same region of Italy were compared so that climate differences were less likely to affect the results.

To match time on the field, the researchers did not track injuries that occurred during practice.

Overall, 1270 hours of play on artificial turf and 1310 hours on natural grass were evaluated. Although slightly more injuries occurred on artificial turf than on natural grass, the difference was not statistically significant (P > .05).

Table. Injuries Occurring During the Study Period

Characteristics of Injury Natural Grass, n Artificial Turf, n
Total injuries 20 23
Circumstance of injury    
   Contact 5 10
   Noncontact 15 13
Type of injury    
   Strain 15 13
   Contusion 1 6
   Other 4 4


These findings are consistent with those from other studies of soccer played on third-generation artificial turf, say the researchers; however, they note that a recent study found significantly more anterior cruciate ligament injuries on artificial turf than on natural grass in American football games (Knee. 2013:20;191-195).

They acknowledge that the difference between the 2 sports could account for the difference in injury rates.

Artificial turf has some advantages over natural turf, said Brian Cole, MD, who is a physician for the Chicago White Sox Major League Baseball team. With turf, "you don't get the undulations," he told Medscape Medical News.

Dr. Cole, who is also a professor of orthopedics at Rush University in Chicago, said he would like to know the number of players involved in the study. Because injuries during a season are relatively rare, a large number of individuals would be needed for the study to have statistical power.

Dr. Ciompi explained that his team used hours of play rather than individual players to calculate their statistics because some players get more time in matches than others.

Dr. Cole and Dr. Ciompi have disclosed no relevant financial relationships.

American Academy of Orthopaedic Surgeons (AAOS) 2014 Annual Meeting: Abstract P443. Presented March 11, 2014.


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