Artificial Turf vs. Grass: The Debate Continues

May 21, 2019 | Knee, Sports Technology

By Dev K. Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • A recently published research study shows an increased risk of some knee injuries in NCAA football played on artificial turf vs. natural grass
  • One important limitation in the study is that it pooled results with earlier versions of artificial turf versus the newest generations of artificial turf
  • The results may be different if looking only at the newest generations of turf, or in other sports and age groups

We’ve come a long way from the earliest versions of artificial turf, which were essentially large pieces of green plastic laid down over cement. The newest generations of artificial turf are radically better than the very first versions, yet the debate over which type of surface is best from a safety standpoint continues.

We’ll highlight this week some of the latest published research in this debate. In a large series specifically studying collegiate tackle football, it was determined that playing on artificial turf was an increased risk for PCL injuries in Division I players and for ACL injuries in Division II and Division III players.

While there are many strengths in this study, I would caution that the results are specific to American collegiate tackle football and may not be similar in other sports or in youth age groups.

This study utilized the NCAA injury surveillance system, and included athletes from the 2004 through the 2014 seasons. To my knowledge this is the largest series of its kind. Aside from the large sample size I find that some of the strengths of the study are that it is free from industry bias, it included practice sessions and competitive games, and it looked at a number of different injury types.

One of the important cautions in this type of study is that over this long period of time artificial turf surfaces went through a number of significant changes. The surface improved, becoming more “grass like”. And very importantly the infill and under surface improved dramatically. What this means as far as this current study is that the surfaces towards the end of the study are not the same type of surfaces at the beginning of the study.

The results from this study are consistent with previously published studies. Other studies have shown increased risk of ACL tears in football played on artificial turf versus grass. Most studies have focused on players in NCAA football and in the NFL. We still don’t have enough data for players and other age groups or other sports.

From the standpoint of a high school, community, or recreational organization I can certainly see the appeal of artificial turf versus natural grass. Natural grass can be very costly and difficult to maintain particularly in areas of the country that face bad weather.

My gut feeling is that the best surface for outdoor field sports is still a perfectly maintained natural grass field. But the quality of the artificial turf surfaces has improved so much in the last 10 years that I also have a feeling future studies of injury risk on the newer surfaces will continue to improve tremendously.



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