Knee Injuries: Conservative Management, Operative Management, and Return to Sport

  • Nicole A. Friel
  • Drew A. Lansdown
  • Brian J. ColeEmail author


Knee injuries are common in all age groups, including the increasingly active population of masters athletes. Knee injuries in this age group range from acute injuries such as ACL tears to degenerative changes leading to osteoarthritis. Appropriate treatment allows the athlete to not only return to physical activity but also to maintain the mental benefits associated with exercise. Acute injury such as an ACL tear can be treated non-operatively with physical therapy in a select group of patients, but high-demand athletes involved in activities with directional change benefit from ACL reconstruction. Knee osteoarthritis is addressed with a progression of treatment options, including maintenance of a healthy weight, physical therapy, bracing, oral supplements, NSAIDs, and varying intra-articular injections, including corticosteroid, hyaluronic acid, and biologic injections. Surgical treatments include cartilage restoration, osteotomy, and partial or total knee arthroplasty. The ultimate goal is to increase function and decrease pain to allow the masters athlete return to activity.


Knee Injury Osteoarthritis Masters athlete Aging athlete 


  1. 1.
    Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F, National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis Rheum. 2008;58(1):26–35. Scholar
  2. 2.
    Mall NA, Frank RM, Saltzman BM, Cole BJ, Bach BR Jr. Results after anterior cruciate ligament reconstruction in patients older than 40 years: how do they compare with younger patients? A systematic review and comparison with younger populations. Sports Health. 2016;8(2):177–81. Scholar
  3. 3.
    Baker CL Jr, Jones JC, Zhang J. Long-term outcomes after anterior cruciate ligament reconstruction in patients 60 years and older. Orthop J Sports Med. 2014;2(12):2325967114561737. Scholar
  4. 4.
    Cheng Y, Hootman J, Murphy L, Langmaid G, Helmich C. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation-United States, 2007-2009. Morb Mortal Wkly Rep. 2010;59(39):1261–5.Google Scholar
  5. 5.
    Losina E, Weinstein AM, Reichmann WM, Burbine SA, Solomon DH, Daigle ME, Rome BN, Chen SP, Hunter DJ, Suter LG. Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res. 2013;65(5):703–11.CrossRefGoogle Scholar
  6. 6.
    Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, Fang F, Schwartz TA, Abbate LM, Callahan LF. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007;34(1):172–80.PubMedGoogle Scholar
  7. 7.
    Bernstein A, Hing E, Moss A, Allen K, Siller A, Tiggle R. Health care in America: trends in utilization. Hyattsville: National Center for Health Statistics; 2003.Google Scholar
  8. 8.
    Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, Dragomir A, Kalsbeek WD, Luta G, Jordan JM. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Care Res. 2008;59(9):1207–13. Scholar
  9. 9.
    Adams T, Band-Entrup D, Kuhn S, Legere L, Mace K, Paggi A, Penney M. Physical therapy management of knee osteoarthritis in the middle-aged athlete. Sports Med Arthrosc Rev. 2013;21(1):2–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Aaboe J, Bliddal H, Messier S, Alkjaer T, Henriksen M. Effects of an intensive weight loss program on knee joint loading in obese adults with knee osteoarthritis. Osteoarthr Cartil. 2011;19(7):822–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Pollard H, Ward G, Hoskins W, Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. J Can Chiropr Assoc. 2008;52(4):229.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Deyle GD, Allison SC, Matekel RL, Ryder MG, Stang JM, Gohdes DD, Hutton JP, Henderson NE, Garber MB. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005;85(12):1301–17.PubMedGoogle Scholar
  13. 13.
    Farr JN, Going SB, McKnight PE, Kasle S, Cussler EC, Cornett M. Progressive resistance training improves overall physical activity levels in patients with early osteoarthritis of the knee: a randomized controlled trial. Phys Ther. 2010;90(3):356–66.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Weng M-C, Lee C-L, Chen C-H, Hsu J-J, Lee W-D, Huang M-H, Chen T-W. Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis. Kaohsiung J Med Sci. 2009;25(6):306–15.CrossRefPubMedGoogle Scholar
  15. 15.
    Patrick DL, Ramsey SD, Spencer AC, Kinne S, Belza B, Topolski TD. Economic evaluation of aquatic exercise for persons with osteoarthritis. Med Care. 2001;39(5):413–24.CrossRefPubMedGoogle Scholar
  16. 16.
    Penninx BW, Messier SP, Rejeski WJ, Williamson JD, DiBari M, Cavazzini C, Applegate WB, Pahor M. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Arch Intern Med. 2001;161(19):2309–16.CrossRefPubMedGoogle Scholar
  17. 17.
    Penninx BW, Rejeski WJ, Pandya J, Miller ME, Di Bari M, Applegate WB, Pahor M. Exercise and depressive symptoms a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol Ser B Psychol Sci Soc Sci. 2002;57(2):P124–32.CrossRefGoogle Scholar
  18. 18.
    Rejeski WJ, Brawley LR, Ettinger W, Morgan T, Thompson C. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Med Sci Sports Exerc. 1997;29(8):977–85.CrossRefPubMedGoogle Scholar
  19. 19.
    Shamliyan TA, Wang S-Y, Olson-Kellogg B, Kane RL. Physical therapy interventions for knee pain secondary to osteoarthritis: a systematic review. Ann Intern Med. 2012;157(9):632–44.CrossRefPubMedGoogle Scholar
  20. 20.
    van Gool CH, Penninx BW, Kempen GI, Rejeski WJ, Miller GD, van Eijk JTM, Pahor M, Messier SP. Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. Arthritis Care Res. 2005;53(1):24–32.CrossRefGoogle Scholar
  21. 21.
    Raja K, Dewan N. Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review. Am J Phys Med Rehabil. 2011;90(3):247–62. Scholar
  22. 22.
    Barnes CL, Cawley PW, Hederman B. Effect of CounterForce brace on symptomatic relief in a group of patients with symptomatic unicompartmental osteoarthritis: a prospective 2-year investigation. Am J Orthop (Belle Mead NJ). 2002;31(7):396–401.Google Scholar
  23. 23.
    Squyer E, Stamper DL, Hamilton DT, Sabin JA, Leopold SS. Unloader knee braces for osteoarthritis: do patients actually wear them? Clin Orthop Relat Res. 2013;471(6):1982–91.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bassleer C, Rovati L, Franchimont P. Stimulation of proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritic articular cartilage in vitro. Osteoarthr Cartil. 1998;6(6):427–34.CrossRefPubMedGoogle Scholar
  25. 25.
    Uebelhart D, Thonar EJA, Zhang J, Williams JM. Protective effect of exogenous chondroitin 4, 6-sulfate in the acute degradation of articular cartilage in the rabbit. Osteoarthr Cartil. 1998;6:6–13.CrossRefPubMedGoogle Scholar
  26. 26.
    Adebowale AO, Cox DS, Liang Z, Eddington ND. Analysis of glucosamine and chondroitin sulfate content in marketed products and the Caco-2 permeability of chondroitin sulfate raw materials. J Am Nutrac Assoc. 2000;3(1):37–44.Google Scholar
  27. 27.
    Russell AS, Aghazadeh-Habashi A, Jamali F. Active ingredient consistency of commercially available glucosamine sulfate products. J Rheumatol. 2002;29(11):2407–9.PubMedGoogle Scholar
  28. 28.
    McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA. 2000;283(11):1469–75.CrossRefPubMedGoogle Scholar
  29. 29.
    Gore M, Tai KS, Sadosky A, Leslie D, Stacey BR. Use and costs of prescription medications and alternative treatments in patients with osteoarthritis and chronic low back pain in community-based settings. Pain Pract. 2012;12(7):550–60.CrossRefPubMedGoogle Scholar
  30. 30.
    da Costa BR, Reichenbach S, Keller N, Nartey L, Wandel S, Jüni P, Trelle S. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet. 2016;387(10033):2093–105. Scholar
  31. 31.
    Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron J, Bombardier C, Cannon C, Farkouh M, FitzGerald G. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382(9894):769–79.CrossRefPubMedGoogle Scholar
  32. 32.
    Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, Jüni P. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Roberts E, Nunes VD, Buckner S, Latchem S, Constanti M, Miller P, Doherty M, Zhang W, Birrell F, Porcheret M. Paracetamol: not as safe as we thought? A systematic literature review of observational studies. Ann Rheum Dis. 2016;75(3):552–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Creamer P. Intra-articular corticosteroid injections in osteoarthritis: do they work and if so, how? Ann Rheum Dis. 1997;56(11):634–5.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Jüni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, da Costa BR. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015;(10):CD005328.Google Scholar
  36. 36.
    Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–74.CrossRefGoogle Scholar
  37. 37.
    McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–88. Scholar
  38. 38.
    Bannuru RR, Natov NS, Dasi UR, Schmid CH, McAlindon TE. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis. Osteoarthr Cartil. 2011;19(6):611–9. Scholar
  39. 39.
    Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003;290(23):3115–21.CrossRefPubMedGoogle Scholar
  40. 40.
    Bannuru RR, Vaysbrot EE, Sullivan MC, McAlindon TE. Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2014;43(5):593–9. Scholar
  41. 41.
    Richette P, Chevalier X, Ea HK, Eymard F, Henrotin Y, Ornetti P, Sellam J, Cucherat M, Marty M. Hyaluronan for knee osteoarthritis: an updated meta-analysis of trials with low risk of bias. RMD open. 2015;1(1):e000071.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Rutjes AW, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012;157(3):180–91.CrossRefPubMedGoogle Scholar
  43. 43.
    Pintan GF, de Oliveira AS Jr, Lenza M, Antonioli E, Ferretti M. Update on biological therapies for knee injuries: osteoarthritis. Curr Rev Muscoskelet Med. 2014;7(3):263–9.CrossRefGoogle Scholar
  44. 44.
    Filardo G, Kon E, Andriolo L, Di Matteo B, Balboni F, Marcacci M. Clinical profiling in cartilage regeneration: prognostic factors for midterm results of matrix-assisted autologous chondrocyte transplantation. Am J Sports Med. 2014;42(4):898–905. Scholar
  45. 45.
    Koh YG, Choi YJ, Kwon SK, Kim YS, Yeo JE. Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2015;23(5):1308–16. Scholar
  46. 46.
    Saito M, Takahashi K, Arai E, Inoue A, Sakao K, Tonomura H, Honjo K, Nakagawa S, Inoue H, Tabata Y. Intra-articular administration of platelet-rich plasma with biodegradable gelatin hydrogel microspheres prevents osteoarthritis progression in the rabbit knee. Clin Exp Rheumatol. 2009;27(2):201.PubMedGoogle Scholar
  47. 47.
    Forogh B, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness. 2016;56(7–8):901–8.PubMedGoogle Scholar
  48. 48.
    Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, Marcacci M, Kon E. Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation a randomized controlled trial. Am J Sports Med. 2015;43(7):1575–82.CrossRefPubMedGoogle Scholar
  49. 49.
    Görmeli G, Görmeli CA, Ataoglu B, Çolak C, Aslantürk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2015;25(3):958–65. Scholar
  50. 50.
    Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR Jr, Cole BJ. Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy. 2015;31(11):2213–21. Scholar
  51. 51.
    Ornetti P, Nourissat G, Berenbaum F, Sellam J, Richette P, Chevalier X, under the aegis of the Osteoarthritis Section of the French Society for Rheumatology. Does platelet-rich plasma have a role in the treatment of osteoarthritis? Joint Bone Spine. 2016;83(1):31–6. Scholar
  52. 52.
    Beitzel K, McCarthy MB, Cote MP, Chowaniec D, Falcone LM, Falcone JA, Dugdale EM, DeBerardino TM, Arciero RA, Mazzocca AD. Rapid isolation of human stem cells (connective progenitor cells) from the distal femur during arthroscopic knee surgery. Arthroscopy. 2012;28(1):74–84.CrossRefPubMedGoogle Scholar
  53. 53.
    Shapiro SA, Kazmerchak SE, Heckman MG, Zubair AC, O’Connor MI. A prospective, single-blind, placebo-controlled trial of bone marrow aspirate concentrate for knee osteoarthritis. Am J Sports Med. 2016;45(1):82–90. Scholar
  54. 54.
    Pascual-Garrido C, Daley E, Verma NN, Cole BJ. A comparison of the outcomes for cartilage defects of the knee treated with biologic resurfacing versus focal metallic implants. Arthroscopy. 2016;33:364. Scholar
  55. 55.
    Mithoefer K, Gill TJ, Cole BJ, Williams RJ, Mandelbaum BR. Clinical outcome and return to competition after microfracture in the Athlete’s knee: an evidence-based systematic review. Cartilage. 2010;1(2):113–20. Scholar
  56. 56.
    Chahal J, Gross AE, Gross C, Mall N, Dwyer T, Chahal A, Whelan DB, Cole BJ. Outcomes of osteochondral allograft transplantation in the knee. Arthroscopy. 2013;29(3):575–88. Scholar
  57. 57.
    Bedi A, Feeley BT, Williams RJ 3rd. Management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010;92(4):994–1009. Scholar
  58. 58.
    Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br. 2008;90(5):592–6. Scholar
  59. 59.
    Bonnin MP, Laurent JR, Zadegan F, Badet R, Pooler Archbold HA, Servien E. Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc. 2013;21(1):64–73. Scholar
  60. 60.
    Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332–54.CrossRefPubMedGoogle Scholar
  61. 61.
    Waterman BR, Hoffmann JD, Laughlin MD, Burks R, Pallis MP, Tokish JM, Belmont PJ Jr. Success of high tibial osteotomy in the United States Military. Orthop J Sports Med. 2015;3(3):2325967115574670. Scholar
  62. 62.
    Salzmann GM, Ahrens P, Naal FD, El-Azab H, Spang JT, Imhoff AB, Lorenz S. Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med. 2009;37(2):312–8. Scholar
  63. 63.
    Howells NR, Salmon L, Waller A, Scanelli J, Pinczewski LA. The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome. Bone Joint J. 2014;96-B(11):1491–7. Scholar
  64. 64.
    Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, Castoldi F, Rossi R. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med. 2014;42(3):690–8. Scholar
  65. 65.
    Foran JR, Brown NM, Della Valle CJ, Berger RA, Galante JO. Long-term survivorship and failure modes of unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2013;471(1):102–8. Scholar
  66. 66.
    O’Rourke MR, Gardner JJ, Callaghan JJ, Liu SS, Goetz DD, Vittetoe DA, Sullivan PM, Johnston RC. The John Insall Award: unicompartmental knee replacement: a minimum twenty-one-year followup, end-result study. Clin Orthop Relat Res. 2005;440:27–37.CrossRefPubMedGoogle Scholar
  67. 67.
    Steele RG, Hutabarat S, Evans RL, Ackroyd CE, Newman JH. Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond ten years. J Bone Joint Surg Br. 2006;88(9):1164–8. Scholar
  68. 68.
    Svard UC, Price AJ. Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br. 2001;83(2):191–4.CrossRefPubMedGoogle Scholar
  69. 69.
    Yim JH, Song EK, Seo HY, Kim MS, Seon JK. Comparison of high tibial osteotomy and unicompartmental knee arthroplasty at a minimum follow-up of 3 years. J Arthroplast. 2013;28(2):243–7. Scholar
  70. 70.
    Spahn G, Hofmann GO, von Engelhardt LV, Li M, Neubauer H, Klinger HM. The impact of a high tibial valgus osteotomy and unicondylar medial arthroplasty on the treatment for knee osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):96–112. Scholar
  71. 71.
    Nwachukwu BU, McCormick FM, Schairer WW, Frank RM, Provencher MT, Roche MW. Unicompartmental knee arthroplasty versus high tibial osteotomy: United States practice patterns for the surgical treatment of unicompartmental arthritis. J Arthroplast. 2014;29(8):1586–9. Scholar
  72. 72.
    Scott CE, Nutton RW, Biant LC. Lateral compartment osteoarthritis of the knee: biomechanics and surgical management of end-stage disease. Bone Joint J. 2013;95-B(4):436–44. Scholar
  73. 73.
    Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. Orthopedics. 2011;34(9):e488–90. Scholar
  74. 74.
    Wang JW, Hsu CC. Distal femoral varus osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am. 2005;87(1):127–33. Scholar
  75. 75.
    Argenson JN, Parratte S, Bertani A, Flecher X, Aubaniac JM. Long-term results with a lateral unicondylar replacement. Clin Orthop Relat Res. 2008;466(11):2686–93. Scholar
  76. 76.
    Lustig S, Elguindy A, Servien E, Fary C, Munini E, Demey G, Neyret P. 5- to 16-year follow-up of 54 consecutive lateral unicondylar knee arthroplasties with a fixed-all polyethylene bearing. J Arthroplast. 2011;26(8):1318–25. Scholar
  77. 77.
    Healy WL, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. 2008;90(10):2245–52. Scholar
  78. 78.
    Parratte S, Argenson JN, Pearce O, Pauly V, Auquier P, Aubaniac JM. Medial unicompartmental knee replacement in the under-50s. J Bone Joint Surg Br. 2009;91(3):351–6. Scholar
  79. 79.
    Lavernia CJ, Sierra RJ, Hungerford DS, Krackow K. Activity level and wear in total knee arthroplasty: a study of autopsy retrieved specimens. J Arthroplasty. 2001;16(4):446–53. Scholar
  80. 80.
    Schmalzried TP, Shepherd EF, Dorey FJ, Jackson WO, dela Rosa M, Fa’vae F, McKellop HA, McClung CD, Martell J, Moreland JR, Amstutz HC. The John Charnley Award. Wear is a function of use, not time. Clin Orthop Relat Res. 2000;(381):36–46.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nicole A. Friel
    • 1
  • Drew A. Lansdown
    • 1
  • Brian J. Cole
    • 2
    Email author
  1. 1.Rush University Medical CenterChicagoUSA
  2. 2.Departments of Orthopedics and Surgery, Rush OPH, Shoulder, Elbow and Knee SurgeryCartilage Restoration Center at Rush, Rush University Medical CenterChicagoUSA

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