Executive Summary
Most reviews of turf-and-injury research summarize findings narratively — this 2023 study, published in eClinicalMedicine (a Lancet-family journal) by researchers at the University of Eastern Finland and Tampere University, is notable for being the first to run a formal statistical meta-analysis specifically on football (soccer) injury incidence by playing surface. Rather than describing which studies leaned which direction, the authors pooled the underlying data to calculate combined incidence rate ratios (IRR) — a more rigorous standard of evidence than a narrative summary alone.
The researchers screened 1,447 studies, evaluated 67 in full, and included 22 in the final meta-analysis.
Key Findings
- Overall football injury incidence was lower on artificial turf than on grass for both men (11 studies; IRR 0.82, 95% CI 0.72–0.94) and women (5 studies; IRR 0.83, 95% CI 0.76–0.91) — both statistically significant reductions.
- Professional players showed a significantly lower injury incidence on artificial turf (8 studies; IRR 0.79, 95% CI 0.70–0.90). Amateur players showed no significant difference between surfaces (8 studies; IRR 0.91, 95% CI 0.77–1.09).
- Knee injuries were significantly less frequent on artificial turf (14 studies; IRR 0.77, 95% CI 0.64–0.92), as were pelvis/thigh injuries (10 studies; IRR 0.72, 95% CI 0.57–0.90).
- Match-specific injury incidence showed a favorable but not statistically significant trend toward turf (IRR 0.86, 95% CI 0.72–1.03 — the confidence interval crosses 1.0, so this result cannot be called definitive on its own).
- The authors’ stated interpretation: the overall incidence of football injuries is lower on artificial turf than on grass, though this finding should not be used as a blanket argument for or against any specific surface — pitch quality and maintenance remain important, independent risk factors regardless of surface type.
Important Limitations
- Risk of bias was a genuine concern the authors flag directly. Only 5 of the 22 included studies statistically adjusted for potential confounding variables (such as playing level, climate, or field maintenance) — meaning the pooled estimates may partly reflect factors other than surface type itself.
- Heterogeneity between studies was high (I² values in the 84–87% range for several subgroup analyses), reflecting real differences in study populations, turf generations, and methodologies being combined.
- The amateur player subgroup showed no significant effect, while the professional subgroup did — a difference that may reflect field quality and maintenance standards typically being higher at the professional level, rather than a property of turf itself.
- Training-specific injury data was limited to a single study and should not be treated as a settled finding.
- As a meta-analysis of observational studies, this research shows association, not proof of causation — it cannot fully rule out that better-resourced clubs and leagues install both higher-quality turf and provide better injury prevention and medical care.
Why This Matters
This is one of the stronger pieces of evidence in the football-specific literature, precisely because it pools data statistically rather than counting which direction more individual studies leaned. For soccer-specific field decisions, the data consistently favors artificial turf on overall injury incidence, with the clearest effects at the professional level and for knee and pelvis/thigh injuries specifically.
The authors’ own caution is worth repeating directly: this finding should not be read as “any turf beats any grass.” What likely drives the effect, at least in part, is that well-maintained, modern turf systems are being compared against a mix of grass fields of varying quality — and field quality and maintenance are consistently identified across the literature as independent risk factors, separate from the surface category itself.
Act Global Perspective
This is one of the more favorable findings in our Research Library for artificial turf specifically in football/soccer, and we think it’s worth presenting with the same care we’d apply to a less favorable study — including the authors’ own caveat that pitch quality and maintenance matter as much as surface category. That caveat is consistent with what we tell every client: a synthetic turf system’s safety performance is a function of construction quality, infill specification, and ongoing maintenance — not something that comes automatically with the material choice.
The professional-versus-amateur split in this data (a significant injury reduction at the professional level, no significant difference at the amateur level) is a useful, honest data point for municipalities and schools evaluating turf on tighter maintenance budgets: the safety benefit synthetic turf can offer is closely tied to build quality and upkeep, which is exactly why Act Global treats specification and maintenance guidance as part of every installation, not an optional add-on.
Related Resources
- Lower Extremity Injury Rates on Artificial Turf vs. Natural Grass — Review of Gould et al. 2023
- ACL Injury Risk on Synthetic Turf vs. Natural Grass — Review of Howard et al. 2020
- Synthetic Turf vs. Natural Grass — Why Consistency Matters More (link once published)
Access the Original Study
This review is Act Global’s independent summary of publicly available peer-reviewed research, prepared for educational purposes. Act Global does not host or reproduce the original article. Read the full study directly from the publisher (open access):
- Kuitunen I, Immonen V, Pakarinen O, Mattila VM, Ponkilainen VT. “Incidence of football injuries sustained on artificial turf compared to grass and other playing surfaces: a systematic review and meta-analysis.” eClinicalMedicine, 59:101956, 2023. DOI: 10.1016/j.eclinm.2023.101956
This is an Act Global Research Review — an independent interpretation of publicly available peer-reviewed research prepared for educational purposes only. It does not constitute medical, legal, or engineering advice.
