Adductor-related groin injury: Prevalence and etiology during NCAA football games on artificial and natural grass surfaces.

Background: Groin injuries can be detrimental to an athlete's health and performance. Prior studies evaluating musculoskeletal injuries on artificial turf versus natural grass have resulted in equivocal findings; however, few studies have compared the occurrence of groin trauma between the two surfaces.

Objective: To quantify the incidence and etiology of groin trauma during college football games across artificial and natural grass surfaces.

Design: Prospective Cohort.

Setting: University.

Participants: Athletic trainers from 41 Football Bowl Subdivision universities evaluated injuries sustained by collegiate football athletes while competing on artificial or natural grass surfaces. The universities were selected based on the availability of both playing surfaces during the competitive season, consistent sport skill level, and the presence of a full-time certified athletic trainer. Artificial surfaces included in the study were limited to heavyweight infill systems (≥9.0 lbs/ft²) to minimize infill system weight influences on trauma.

Interventions: Not applicable.

Main outcome measure(s): Adductor injury severity, classification, category, primary type, mechanism and situation, player position, skill position, cleat design, field conditions, environmental conditions, imaging and surgical procedures, and turf age. Injury incidence rates were calculated using injuries per 10 games = [(number of injuries ÷ number of games) × 10].

Results: Of the 2243 games documented, 1061 (47.3%) were played on artificial turf and 1182 games (52.7%) on natural grass. In sum, of 9360 total injuries, 111 (1.2%) adductor-related groin injuries were recorded with 48 (43.2%) occurring on artificial turf, and 63 (56.8%) on natural grass. Multivariate analyses of variance indicated no significant surface effect by any outcomes of interest. Cases occurred most frequently as minor muscle strains (87%), during defensive play (41%) and noncontact sprinting (39%).

Conclusion: Regarding adductor-related groin trauma, heavyweight artificial turf is as safe as natural grass. Focus should be placed on early detection and understanding long-term health outcomes rather than surface influence. An athlete who sustains such an injury may benefit from engaging in a structured resistance training program that progresses from general lower-body development in the days after injury to adductor-specific training in the weeks following. The results of this study are generalizable only to this level of competition.