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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. [ABSTRACT FROM AUTHOR]

This study sought to develop a strain-based probabilistic method to predict rib fracture risk with whole-body finite element (FE) models, and to describe a method to combine the results with collision exposure information to predict injury risk and potential intervention effectiveness in the field. An age-adjusted ultimate strain distribution was used to estimate local rib fracture probabilities within an FE model. These local probabilities were combined to predict injury risk and severity within the whole ribcage. The ultimate strain distribution was developed from a literature dataset of 133 tests. Frontal collision simulations were performed with the THUMS (Total HUman Model for Safety) model with four levels of delta-V and two restraints: a standard 3-point belt and a progressive 3.5-7 kN force-limited, pretensioned (FL+PT) belt. The results of three simulations (29 km/h standard, 48 km/h standard, and 48 km/h FL+PT) were compared to matched cadaver sled tests. The numbers of fractures predicted for the comparison cases were consistent with those observed experimentally. Combining these results with field exposure informantion (ΔV, NASS-CDS 1992-2002) suggests a 8.9% probability of incurring AIS3+ rib fractures for a 60 year-old restrained by a standard belt in a tow-away frontal collision with this restraint, vehicle, and occupant configuration, compared to 4.6% for the FL+PT belt. This is the first study to describe a probabilistic framework to predict rib fracture risk based on strains observed in human-body FE models. Using this analytical framework, future efforts may incorporate additional subject or collision factors for multi-variable probabilistic injury prediction.

Frontal-impact airbag systems have the potential to provide a benefit to rear seat occupants by distributing restraining forces over the body in a manner not possible using belts alone. This study sought to investigate the effects of incorporating a belt-integrated airbag ("airbelt") into a rear seat occupant restraint system. Frontal impact sled tests were performed with a Hybrid III 50th percentile male anthropomorphic test device (ATD) seated in the right-rear passenger position of a 2004 mid-sized sedan buck. Tests were performed at 48 km/h (20 g, 100 ms acceleration pulse) and 29 km/h (11 g, 100 ms). The restraints consisted of a 3-point belt system with a cylindrical airbag integrated into the upper portion of the shoulder belt. The airbag was tapered in shape, with a maximum diameter of 16 cm (at the shoulder) that decreased to 4 cm at the mid-chest. A 2.5 kN force-limiter was integrated into the shoulder-belt retractor, and a 2.3 kN pretensioner was present in the out-board anchor of the lap belt. Six ATD tests (three 48 km/h and three 29 km/h) were performed with the airbelt system. These were compared to previous frontal-impact, rear seat ATD tests with a standard (not-force-limited, not-pretensioned) 3-point belt system and a progressive force-limiting (peak 4.4 kN), pretensioning (FL+PT) 3-point belt system. In the 48 km/h tests, the airbelt resulted in significantly less (p<0.05, two-tailed Student's t-test) posterior displacement of the sternum towards the spine (chest deflection) than both the standard and FL+PT belt systems (airbelt: average 13±1.1 mm standard deviation; standard belt: 33±2.3 mm; FL+PT belt: 23±2.6 mm). This was consistent with a significant reduction in the peak upper shoulder belt force (airbelt: 2.7±0.1 kN; standard belt: 8.7±0.3 kN; FL+PT belt: 4.4±0.1 kN), and was accompanied by a small increase in forward motion of the head (airbelt: 54±0.4 cm; standard belt: 45±1.3 cm; FL+PT belt: 47±1.1 cm) The airbelt system also significantly reduced the flexion moment in the lower neck (airbelt: 169±3.3 Nm; standard belt: 655±26 Nm; FL+PT belt: 308±19 Nm). Similar results were observed in the 29 km/h tests. These results suggest that this airbelt system may provide some benefit for adult rear seat occupants in frontal collisions, even in relatively low-speed impacts. Further study is needed to evaluate this type of restraint system for different size occupants (e.g., children), for out-of-position occupants, and with other occupant models (e.g., cadavers).

The Hybrid III 6-year-old ATD has been benchmarked against adult-scaled component level tests but the lack of biomechanical data hinders the effectiveness of the procedures used to scale the adult data to the child. Whole body kinematic validation of the pediatric ATD through limited comparison to post mortem human subjects (PMHS) of similar age and size has revealed key differences attributed to the rigidity of the thoracic spine. As restraint systems continue to advance, they may become more effective at limiting peak loads applied to occupants, leading to lower impact environments for which the biofidelity of the ATD is not well established. Consequently, there is a growing need to further enhance the assessment of the pediatric ATD by evaluating its biofidelity at lower crash speeds. To this end, this study compared the kinematic response of the Hybrid III 6 year old ATD against size-matched male pediatric volunteers (PVs) (6-9 yrs) in low-speed frontal sled tests. A 3-D near-infrared target tracking system quantified the position of markers at seven locations on the ATD and PVs (head top, opisthocranion, nasion, external auditory meatus, C4, T1, and pelvis). Angular velocity of the head, seat belt forces, and reaction forces on the seat pan and foot rest were also measured. The ATD exhibited significantly greater shoulder and lap belt, foot rest, and seat pan normal reaction loads compared to the PVs. Contrarily, PVs exhibited significantly greater seat pan shear. The ATD experienced significantly greater head angular velocity (11.4 ± 1.7 rad/s vs. 8.1 ± 1.4 rad/s), resulting in a quicker time to maximum head rotation (280.4 ± 2.5 ms vs 334.2 ± 21.7 ms). The ATD exhibited significantly less forward excursions of the nasion (171.7 ± 7.8 mm vs. 199.5 ± 12.3 mm), external auditory meatus (194.5 ± 11.8 mm vs. 205.7 ± 10.3 mm), C4 (127.0 ± 5.2 mm vs. 183.3 ± 12.8 mm) and T1 (111.1 ± 6.5 mm vs. 153.8 ± 10.5 mm) compared to the PVs. These analyses provide insight into aspects of ATD biofidelity in low-speed crash environments.

Pediatric and adult ATD's are key tools for the development of motor vehicle crash safety systems. Previous researchers developed size-based scaling methods to adapt blunt chest impact data from adult post-mortem human subjects (PMHS) for pediatric ATD chests design requirements, using skull or femur elastic modulus ratios to estimate the change in whole chest stiffness during maturation. Recently, the mechanics of chest compression during cardiopulmonary resuscitation (CPR) of patients spanning the pediatric and elderly ages have been reported. Our objective was to integrate these pediatric and adult chest stiffness data from CPR into the established scaling methods to 1) compare new CPR-based and existing pediatric ATD chest biofidelity response requirements and 2) develop new CPR-based corridors for ages 12 and 20 years, which do not currently exist. Compared to the current 6-year-old ATD corridor, the maximum force of the CPR-based 6-year-old corridor was 7% less and the maximum displacement was 8% greater, indicating a softer chest. Compared to the current 10-year-old corridor, the new 10-year-old corridor peak force was 12% higher and the peak displacement was 11% smaller, suggesting a stiffer chest. The 12-year-old corridor developed in this paper was 10% higher in maximum force and 4% lower in maximum displacement compared with the adult 5(th) percentile female (AF05). Finally, the 20-year-old 50(th) percentile male (AM50(20)) corridor was 24% higher in maximum force and 19% lower in maximum displacement than 63-year old 50(th) percentile adult male (AM50(63)) corridor, suggesting a stiffer chest. We consider all the new corridors preliminary, as data collection is ongoing for CPR subjects under age 8 years and in the young and middle adult age ranges.