891 FO58 – Equal playing fields? The influence of playing surface on injury risk in elite female rugby union (2018–2022)

Background A significant proportion (up to 40%) of elite women's rugby teams in England play on artificial surfaces. Artificial surfaces have been associated with increased injury burden in the men's professional game; however, the influence of these surfaces on injury risk for female rugby union players remains to be investigated. Objectives To investigate the influence of playing surface on match-related injury incidence, severity, and burden within elite women's rugby union in England. Design Retrospective cohort study across 4 seasons (2018/19 – 2021/22). Setting A total of 12 teams competing in the English Premiership competition. Participants Elite female rugby union players. Assessment of Risk Factors Playing surface (artificial turf [AT] versus natural grass/hybrid [NG]). Main Outcome Measurements Incidence rate, mean severity, and burden of time-loss match injuries. Z-tests were used to assess rate ratios (RR), with NG as the reference group. Results There were 498 injuries reported across both playing surfaces (213 AT, 285 NG), with no significant differences observed in overall injury incidence, severity, or burden. The incidence of knee injuries was significantly higher on AT (7.1/1000 h) than on NG (4.3/1000 h; RR: 1.67, P = 0.03), with the most frequent knee injury type on AT being joint and ligament injuries (3.7/1000 h). The incidence of ankle injuries was also significantly greater on AT (6.2/1000 h vs. 3.7/1000 h; RR: 1.65, P = 0.05). There was a significantly lower burden of head and neck injuries on AT (394/1000 days on NG vs. 250/1000 days on AT; RR: 0.64, P = 0.009). Conclusions The overall risk associated with playing rugby union on AT was comparable to NG surfaces for elite female players. However, the incidence of ankle and knee injuries was significantly higher on AT, and so future preventative efforts should focus on footwear-to-surface interface factors.