Creatine: Clinical Implications for Orthopedic Surgeons

Many athletes and active individuals use nutritional supplements for performance, muscle mass, and recovery. Creatine developed popularity in the 1990s and has continued today. During high-intensity exercise, anaerobic glycolysis and the phosphocreatine shuttle provide adenosine triphosphate (ATP). In older adults, creatine supplementation with resistance training has been shown to increase muscle mass and strength in some studies. Evidence to support creatine supplementation in adolescent and pediatric patients is limited. The most common side effect is weight gain, and there do not appear to be any adverse effects on renal function in healthy athletes. In the few studies to date, the role of creatine in postoperative recovery has not been clearly established. This review summarizes the basic science of creatine, its potential role in recovery and supplementation, and its safety profile.