Executive Summary
Most injury research compares how often injuries happen. This 2024 study, published in the Orthopaedic Journal of Sports Medicine by researchers at Idaho State University’s Human Performance Laboratory, asked a different question: once an injury happens, how often does it actually require imaging (X-ray, CT, MRI) or surgery, a more direct measure of injury severity than incidence alone. It is, by the authors’ own account, the most extensive multi-team prospective study to date addressing post-game medical procedures specifically tied to playing surface in collegiate football.
The study tracked 39 universities across all NCAA Football Bowl Subdivision conferences over 15 seasons (2006–2020), comparing heavyweight artificial turf infill systems (9.0 lb infill/ft²) against natural grass.
Key Findings
- Study scope: 2,224 games (1,106 on artificial turf, 1,118 on natural grass), 9,137 total injuries, of which 4,010 were surface-related.
- Significantly fewer imaging procedures were ordered after turf-related injuries. Radiographs, CT scans, and MRIs combined were ordered at a rate of 7.1 per 10 games on turf versus 8.6 on natural grass.
- Significantly fewer surgeries were performed after turf-related injuries. 2.1 surgeries per 10 games on turf versus 2.8 on natural grass, including significantly fewer ankle surgeries and surgeries involving ligament tears specifically.
- Specific diagnoses were significantly less frequent on turf, including foot injuries, ligament sprains/tears, muscle strains/tears, syndesmosis sprains/tears, and Lisfranc injuries.
- No significant difference between surfaces was found for knee-specific diagnoses (ACL, MCL, meniscus, etc.), the surface difference showed up more in ankle/foot and overall procedure volume than in knee-specific outcomes.
- An important trend, independent of surface: combined medical procedures and substantial/severe injuries both increased significantly over the 15-year period, a rise the authors attribute to athletes becoming larger and faster, improved diagnostic access, and possibly rule changes shifting injury patterns, not to turf becoming less safe over time.
Important Limitations
- Funding disclosure: the study’s lead author received research support from FieldTurf USA, a competing turf manufacturer, disclosed per journal policy. We think this is important to state plainly rather than omit, even though it doesn’t specifically involve Act Global.
- The study evaluated one specific infill weight class (heavyweight, 9.0 lb infill/ft²), findings may not generalize to lighter infill systems, and the authors note heavier infill has separately been associated with greater safety than lighter systems.
- This measures medical procedure incidence, not long-term outcomes, it doesn’t address quality-of-life differences or re-injury rates beyond the season studied.
- As an observational cohort study, it cannot fully control for confounding factors the authors themselves list at length: athlete conditioning, coaching style, weather, field maintenance quality, and officiating, among others.
- Findings are specific to the collegiate FBS level and may not generalize to youth, high school, or lower-resourced programs with different maintenance standards.
Why This Matters
This is one of the largest and longest-running studies in this library, and its focus on actual medical intervention — not just reported injury counts — makes it a meaningfully different, and arguably more clinically relevant, measure of severity. The finding that heavyweight artificial turf was associated with fewer imaging procedures and surgeries, including specifically fewer ankle and ligament surgeries, runs counter to the perception that turf is categorically harder on the body. The authors are direct about this contrast themselves, noting their results run “in contrast to perception and anecdotal experience.”
The disclosed FieldTurf funding doesn’t invalidate the findings — the study design, sample size, and statistical rigor are strong — but it’s a relevant piece of context for readers to weigh alongside the results, the same way we’d want a reader to weigh it for any industry-funded research, including if it came from a source funding our own claims.
Act Global Perspective
We’re including this study’s funding disclosure prominently because we think the same transparency standard should apply whether a study helps or hurts the case for turf — and this one helps. The specific finding about infill weight is also directly useful: it reinforces that infill specification (not just “turf vs. grass” as a category) is a meaningful, engineerable safety variable, consistent with what we cover in our Infill Options article.
We’d also point to the study’s own closing note as good guidance for any field owner: safety outcomes should be evaluated through research-supported data specific to a system’s actual specification, not through general perception in either direction.
Related Resources
- Infill Options & Environmental Considerations
- Injury Surveillance in Major League Soccer — Review of Calloway et al. 2019
- Knee Injury Incidence in NCAA Football — Review of Loughran et al. 2019
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):
- Meyers MC, Sterling JC, Robinson SK. “Imaging and Surgical Procedures After Surface-Related Collegiate Football Injuries on Artificial Turf Versus Natural Grass: Prevalence and Trends Over 15 Seasons.” Orthopaedic Journal of Sports Medicine, 12(9), 2024. DOI: 10.1177/23259671241274144
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.
