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Injury incidence and risk factors in youth soccer players: a systematic literature review. Part II: Intrinsic and extrinsic risk factors. Biol Sport 2023; 40:27-49. [PMID: 36636190 PMCID: PMC9806737 DOI: 10.5114/biolsport.2023.109962] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/03/2021] [Accepted: 09/21/2021] [Indexed: 01/16/2023] Open
Abstract
Injury is defined as a complex phenomenon determined by the non-linear interaction of several intrinsic and extrinsic factors. The objective of the present study was to perform a systematic literature review on the injury risk factors in young soccer players. After electronic database searching, articles in line with the inclusion criteria were selected for the systematic review. Injury risk factor data were extracted and grouped in intrinsic and extrinsic risk factors. The main findings of the current review are as follows: (1) alteration in neuromuscular control such as limb asymmetry and dynamic knee valgus are important intrinsic risk factors; (2) maturation status may impair neuromuscular control and increase the risk of injury; (3) fatigue and poor recovery contribute to the onset of overuse injuries; (4) the impact of anthropometric factors is still unclear; (5) previous injuries increase the risk of re-injuries; (6) highly skilled players are more exposed to risk of injuries; (7) high external workloads increase the risk of injuries; (8) playing position, as well as sport specialization, exposes young soccer players to greater injury risk. Many factors (e.g., neuromuscular control, training load, maturity status) can modify the susceptibility to injury in young soccer players. Being aware of the complex interaction between these factors is essential to identify players at higher risk of injury, develop adequate prevention strategies, and from a scientific point of view move from a reductionist to a complex system approach.
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Xiao M, Lemos JL, Hwang CE, Sherman SL, Safran MR, Abrams GD. Increased Risk of ACL Injury for Female but Not Male Soccer Players on Artificial Turf Versus Natural Grass: A Systematic Review and Meta-Analysis. Orthop J Sports Med 2022; 10:23259671221114353. [PMID: 35990873 PMCID: PMC9382072 DOI: 10.1177/23259671221114353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Both natural grass (NG) and artificial turf (AT) are popular playing surfaces
for soccer. Biomechanical studies have found increased frictional forces on
AT that may lead to anterior cruciate ligament (ACL) injury. The increased
risk of ACL injury during soccer in female participants may amplify this
effect. Purpose: To systematically review the literature for studies comparing ACL injury risk
in soccer players on AT versus NG and to specifically determine whether
there were differences in injury risk in male versus female players when
considering the playing surface. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed using PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines. Three databases were
searched for studies with evidence level 1 to 3 that compared the incidence
of ACL injuries on AT versus NG in soccer players. Data recorded included
study characteristics, sex, competition level, exposure setting (games or
practices), turf type, and ACL injury information. Study methodological
quality was analyzed using the methodological index for non-randomized
studies (MINORS) score, and incidence rate ratios (IRRs) were
calculated. Results: Included were 7 articles (3 studying professional soccer, 3 collegiate
soccer, 1 youth-level soccer; 4 male cohorts, 2 female cohorts, and 1 male
and female cohort; mean MINORS score, 20 ± 0.8). Pooled ACL injury IRRs
demonstrated no significant differences in overall ACL injury risk when
playing soccer on AT compared with NG (IRR = 0.57 [95% CI, 0.21-1.53];
P = .31). A significantly increased risk of ACL injury
in games played on AT compared with NG was detected for female (IRR = 1.18
[95% CI, 1.05-1.31]; P = .004) but not for male players
(IRR = 1.18 [95% CI, 0.97-1.42]; P = .09). Subgroup
analyses showed no significant differences in injury risk for games (IRR =
1.07 [95% CI, 0.97-1.18]; P = .20) or practices (IRR = 0.21
[95% CI, 0.04-1.23]; P = .09). Conclusion: Findings indicated that female soccer players had a significantly higher risk
of ACL injury when playing games on AT versus NG, whereas no significant
difference was seen in male players. No differences were found for the
combined male/female cohort or for soccer games or training sessions played
on AT compared with NG.
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Affiliation(s)
- Michelle Xiao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jacie L Lemos
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Calvin E Hwang
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
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Howard M, Solaru S, Kang HP, Bolia IK, Hatch GFR, Tibone JE, Gamradt SC, Weber AE. Epidemiology of Anterior Cruciate Ligament Injury on Natural Grass Versus Artificial Turf in Soccer: 10-Year Data From the National Collegiate Athletic Association Injury Surveillance System. Orthop J Sports Med 2020; 8:2325967120934434. [PMID: 32743012 PMCID: PMC7376298 DOI: 10.1177/2325967120934434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/04/2020] [Indexed: 01/13/2023] Open
Abstract
Background: Anterior cruciate ligament (ACL) injury is prevalent among National
Collegiate Athletic Association (NCAA) soccer players. Controversy remains
regarding the effect of the surface type on the rate of ACL injury in soccer
players, considering differences in sex, type of athletic exposure, and
level of competition. Hypothesis: Natural grass surfaces would be associated with decreased ACL injury rate in
NCAA soccer players. Sex, type of athletic exposure (match vs practice), and
level of competition (Division I-III) would affect the relationship between
playing surface and ACL injury rates. Study Design: Cohort study; Level of evidence, 3. Methods: Using the NCAA Injury Surveillance System (ISS) database, we calculated the
incidence rate of ACL injury in men and women from 2004-2005 through
2013-2014 seasons. The incidence was normalized against athletic exposure
(AE). Additional data collected were sex, athletic activity at time of
injury (match vs practice), and level of competition (NCAA division) to
stratify the analysis. Statistical comparisons were made by calculating
incidence rate ratios (IRR). Statistical significance was set at an alpha of
.05. Results: There were 30,831,779 weighted AEs during the study period. The overall
injury rate was 1.12 ACL injuries per 10,000 AEs (95% CI, 1.08-1.16). Women
comprised 57% of the match data (10,261 games) and 55% of practice data
(26,664 practices). The overall injury rate was significantly higher on
natural grass (1.16/10,000 AEs; 95% CI, 1.12-1.20) compared with artificial
turf (0.92/10,000 AEs [95% CI, 0.84-1.01]; IRR, 1.26 [95% CI, 1.14-1.38])
(P < .0001). This relationship was demonstrated
consistently across all subanalyses, including stratification by NCAA
division and sex. The injury rate on natural grass (0.52/10,000 AEs; 95% CI,
1.11-1.26) was significantly greater than the injury incidence during
practice on artificial turf (0.06/10,000 AEs; 95% CI, 0.043-0.096). Players
were 8.67 times more likely to sustain an ACL injury during practice on
natural grass compared with practice on artificial turf (95% CI, 5.43-12.13;
P < .0001). No significant difference was found in
injury rates between matches played on grass versus turf (IRR, 0.93; 95% CI,
0.84-1.03; P = .15). Conclusion: NCAA soccer players who practice on natural grass have increased risk of ACL
injury compared with the risk of those practicing on an artificial surface,
regardless of sex or NCAA division of play. No difference in risk of ACL
injury between playing surfaces was detected during matches. Further
research is necessary to examine the effect of multiple factors when
evaluating the effect of the surface type on the risk of ACL injury in
soccer players.
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Affiliation(s)
- Mark Howard
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Samantha Solaru
- University of Southern California, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Hyunwoo P Kang
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - George F R Hatch
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - James E Tibone
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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Strutzenberger G, Edmunds R, Nokes LDM, Mitchell ID, Mellalieu SD, Irwin G. Player–surface interactions: perception in elite soccer and rugby players on artificial and natural turf. Sports Biomech 2020; 21:1021-1031. [DOI: 10.1080/14763141.2020.1720279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gerda Strutzenberger
- Department of Sport Science and Kinesiology/USI, University of Salzburg, Salzburg, Austria
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Rob Edmunds
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Ian D. Mitchell
- People and Team Development, the Football Association, Burton Upon Trent, UK
| | - Stephen D. Mellalieu
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Gareth Irwin
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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Calloway SP, Hardin DM, Crawford MD, Hardin JM, Lemak LJ, Giza E, Forsythe B, Lu Y, Patel BH, Osbahr DC, Gerhardt MB, Mandelbaum BR, Baldwin WW. Injury Surveillance in Major League Soccer: A 4-Year Comparison of Injury on Natural Grass Versus Artificial Turf Field. Am J Sports Med 2019; 47:2279-2286. [PMID: 31306590 DOI: 10.1177/0363546519860522] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Artificial playing surfaces are becoming more common due to decreased cost of maintenance and increased field usability across different environmental conditions. The Fédération Internationale de Football Association (FIFA) has approved newer generation artificial turf for soccer competition at the elite level, but many elite-level athletes prefer to play on natural grass surfaces due to a perceived increase in injury rate, discomfort, and fatigability on artificial turf. HYPOTHESIS Injury rates and rates of individually categorized types of injury experienced on artificial turf are noninferior to rates of injury on the standard comparator, natural grass, in elite-level Major League Soccer athletes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Over the course of 4 Major League Soccer seasons (2013-2016), athlete injury data were recorded electronically. Injury data recorded in matches between 2 Major League Soccer teams were then analyzed. Playing surface was known for each venue, and all artificial turf surfaces were rated as 2-star according to FIFA criteria. Incidence rate ratios (Artificial Turf ÷ Natural Grass) were calculated with a 95% CI (α = .05) for both overall injury incidence and individual injury subgroups. A noninferiority margin (δ) of 0.15 was used to determine noninferiority of injury incidence rates. RESULTS A total of 2174 in-game injuries were recorded during the study period, with 1.54 injuries per game on artificial turf and 1.49 injuries per game on natural grass (incidence rate ratio, 1.033; 95% CI, 0.937-1.139). Within injury subgroups, overall ankle injury, Achilles injury, and ankle fracture were found to have a statistically higher incidence on artificial turf. Artificial turf was found to be noninferior to natural grass for overall foot injury and forefoot injury. No statistically significant differences were found in knee injuries between the 2 surfaces. CONCLUSION The overall rate of injury on artificial turf was noninferior to that on natural grass. Within individual injury categories, a higher rate of ankle injury was found on artificial turf. No other injury subgroup demonstrated statistically significant differences between surfaces. CLINICAL RELEVANCE FIFA 2-star rated artificial turf is a viable alternative to natural grass in elite-level soccer competition. Innovative research methods for comparing artificial turf versus natural grass may elucidate relative advantages with respect to player safety.
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Affiliation(s)
- Sean P Calloway
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - David M Hardin
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - Matthew D Crawford
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - J Michael Hardin
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - Lawrence J Lemak
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - Eric Giza
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - Brian Forsythe
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - Yining Lu
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - Bhavik H Patel
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - Daryl C Osbahr
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - Michael B Gerhardt
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - Bert R Mandelbaum
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
| | - William W Baldwin
- Investigation performed at Kerlan Jobe Institute, Santa Monica, California, USA
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Jastifer JR, McNitt AS, Mack CD, Kent RW, McCullough KA, Coughlin MJ, Anderson RB. Synthetic Turf: History, Design, Maintenance, and Athlete Safety. Sports Health 2018; 11:84-90. [PMID: 30096021 PMCID: PMC6299344 DOI: 10.1177/1941738118793378] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT: Synthetic turf has become an increasingly common playing surface for athletics and has changed dramatically since its introduction more than 50 years ago. Along with changes to surface design, maintenance needs and recommendations have become more standardized and attentive both to upkeep and player-level factors. In particular, synthetic turf maintenance as it relates to athlete health and safety is an important consideration at all levels of play. EVIDENCE ACQUISITION: A literature search of MEDLINE and PubMed for publications between the years 1990 and 2018 was conducted. Keywords included s ynthetic turf, artificial turf, field turf, and playing surface. Additionally, expert opinion through systematic interviews and practical implementation were obtained on synthetic turf design and maintenance practices in the National Football League. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 5. RESULTS: Synthetic turf has changed considerably since its inception. Playing surface is a critical component of the athletic environment, playing a role both in performance and in athlete safety. There are several important structural considerations of third-generation synthetic turf systems currently used in the United States that rely heavily on strong and consistent maintenance. A common misconception is that synthetic turf is maintenance free; in fact, however, these surfaces require routine maintenance. Whether athletes experience more injuries on synthetic over natural surfaces is also of interest among various levels and types of sport. CONCLUSION: Modern synthetic turf is far different than when originally introduced. It requires routine maintenance, even at the level of local athletics. It is important for sports medicine personnel to be familiar with playing surface issues as they are often treating athletes at the time of injury and should maintain a level of awareness of contemporary research and practices regarding the relationships between synthetic turf and injury.
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Affiliation(s)
- James R. Jastifer
- James R. Jastifer, MD, Borgess Orthopedics, 2490 South 11th Street, Kalamazoo, MI 49009, USA ()
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Blanchard S, Palestri J, Guer JL, Behr M. Current Soccer Footwear, Its Role in Injuries and Potential for Improvement. Sports Med Int Open 2018; 2:E52-E61. [PMID: 30539118 PMCID: PMC6259463 DOI: 10.1055/a-0608-4229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/24/2018] [Accepted: 03/30/2018] [Indexed: 01/07/2023] Open
Abstract
Soccer is the most popular sport in the world and generates great financial revenue. It is also a sport whose practice has evolved considerably in terms of intensity and commitment, and in which the intrinsic risk of injury (not directly related to an interaction with the environment) is particularly high. In this context, the cleated shoe as a major component of soccer equipment may play a key role in the overexposure to injury. Soccer shoe evolution is all the more challenging, because design and mechanical structure differ in many points compared to other modern shoes developed for sports such as running, tennis and basketball. This critical review aims to elucidate the characteristics of modern soccer footwear and their possible link to soccer-specific injuries, focusing on the following areas: (1) ergonomics, comfort and proprioception; (2) shoe mechanical characteristics; (3) field surfaces and shoe design.
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Affiliation(s)
- Sylvain Blanchard
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, Marseille, France
| | | | - Jean-Luc Guer
- Wizwedge SARL, Research Department, Marseille, France
| | - Michel Behr
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, Marseille, France
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Diniz da Silva C, Braga CP, Pollard R. The effect on home advantage when a team changes from grass to artificial turf – a worldwide study in professional football. INT J PERF ANAL SPOR 2018. [DOI: 10.1080/24748668.2018.1475196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Cristiano Diniz da Silva
- Research Group in Applied Soccer Sciences, Department of Physical Education, Institute of Life Sciences, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Cícero Paschoal Braga
- Research Group in Applied Soccer Sciences, Department of Physical Education, Institute of Life Sciences, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Richard Pollard
- Statistics Department, California Polytechnic State University, San Luis Obispo, CA, USA
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