Abstract
There is a high incidence of anterior cruciate ligament (ACL) tears in National Football
League (NFL) players. There is a relative paucity of long-term data characterizing
the effects of artificial versus natural playing surfaces on ACL tear incidence. A
comprehensive search of publicly available data identified any NFL player who sustained
an ACL injury from 2012 to 2022. The publicly available databases allowed for characterization
of playing surface, player position, timing of injury in season, mechanism of injury,
and player's age. Incidence of ACL injuries by playing surface, player position, and
position group relative to all other positions or position groups were compared by
chi-squared test. Correlates of in-game ACL injury were determined by stepwise multivariate
logistic regression. There were 520 NFL players who experienced an ACL tear between
seasons 2012–2013 and 2022–2023. There was no significant difference in incidence
of ACL tears on artificial turf versus natural playing surfaces (265 versus 255, p = 0.670). Wide receivers (p = 0.027) were associated with a significantly higher incidence of ACL tears compared
with other positions. Receivers (wide receivers and tight ends) (p = 0.007) were associated with significantly higher incidence of ACL tears compared
with other position groups, while specialists (punters, kickers, and long snappers)
(p < 0.001) were associated with significantly lower incidence of ACL tears compared
with other position groups. No significant difference between mechanism of injury
between playing surfaces was found (p = 0.765). More ACL tears occurred before week 9 than on or after week 9 in-season,
and the proportion of ACL tears occurring during a game (67%) was significantly higher
than those occurring during practice. There was no statistically significant difference
in incidence of ACL tears in NFL players from the 2012–2013 to 2022–2023 seasons based
on playing surface (artificial versus natural). Wide receivers had a significantly
higher incidence of ACL tears compared with other positions and tears were more common
during games and before week 9 in-season.
Keywords
anterior cruciate ligament - National Football League - natural grass - artificial
turf - knee injury
