Risk of Anterior Cruciate Ligament Injury in Athletes on Synthetic Playing Surfaces

Abstract

High-quality studies support an increased rate of ACL injury on synthetic playing surfaces in football, but there is no apparent increased risk in soccer. Further study is needed to clarify the reason for this apparent discrepancy.

Risk factors of anterior cruciate ligament injury in football players: a systematic review of the literature

“…Balazs et al 27 performed a systematic literature review and synthesized 6 cohort studies. No increased risk of ACL ruptures when playing on synthetic surfaces was found.…”

Effect of Neurocognition and Concussion on Musculoskeletal Injury Risk

“…These include anatomical ( e g ., femoral intercondyle notch width) (43), neuromuscular ( e g ., altered biomechanics during high-risk athletic tasks) (14), hormonal ( e g ., cyclical changes in joint laxity) (8), and environmental ( e g ., playing surface type and condition, level of competition) (4) risk factors. The identification of these risk factors has subsequently led to the development of several injury risk stratification and prevention protocols (6,15).…”

One Anterior Cruciate Ligament injury is enough!: Focus on female football players

“…Despite the multifactorial nature of ACL injury, most studies have examined isolated risk factors [179,195]. Many articles of proposed risk factors for ACL are narrative reviews [1,88,89,203], systematic reviews [5,19,92,196,197,221] or current concepts statement [180,195] that include case-control studies [38,82,91,110,123,139,144,174,204] in addition to prospectively designed studies [90,95,117,149,159,160,164,165,199,216,218,219,241,242] (Table 1). To definitively establish risk factors for ACL injury, high quality prospective studies are needed.…”

“…Non-modifiable  Female sex [221]  High ligamentous laxity (generalized and specific) [110,144,216]  Small femoral notch size [199,216]  Small ACL volume [38]  Increased posterior tibial slope [82]  Genu recurvatum [110,123]  Increased subtalar pronation [123]  Previous ACL injury [165,218]  Previous ankle injury [110]  Heredity for ACL [95,174]  Preovulatory menstrual status [92] Modifiable  High BMI [216]  Neuromuscular control deficits [90,91,241,242]  Biomechanical deficits [90]  Muscle fatigue [5,27]  Neurocognitive function deficits [204] Non-modifiable  Weather condition (hot, dry) [160][161][162] Modifiable  High shoe surface friction [117]  Artificial playing surface [19,159,164]  Contact sport [64]  Cutting and pivoting sports [64]  High level of competition [149,219] Intrinsic factors Neuromuscular and biomechanical factors include differences in landing and pivoting biomechanics between injured and non-injured patients [1]. ACL-injured females have decreased isokinetic hamstring strength and recruitment (relative to quadriceps) [139], increased lateral trunk displacement, knee abduction and intersegmental abduction moment, and greater ...…”

“…Playing on artificial turf compared with natural grass has been debated as a risk factor for ACL injury. Studies support an increased rate of ACL injury on artificial turf in American football, but there is no apparent increased risk in football (soccer) [19,95]. There is a lack of randomized controlled studies regarding footwear, but one study regarding football cleat designs found a higher number and longer cleats were associated with a higher risk of sustaining an ACL injury [117].…”