Table Of ContentOrthopaedic Basic Science
Foundations of Clinical Practice
FIFTH EDITION
Edited by
Roy K. Aaron, MD
Professor, Orthopedic Surgery
Professor, Molecular Pharmacology, Physiology, and Biotechnology
Warren Alpert Medical School of Brown University
Providence, Rhode Island
Board of Directors, 2019-2020
Kristy L. Weber, MD
President
Joseph A. Bosco, III, MD
1st Vice President
Daniel K. Guy, MD
2nd Vice President
Alan S. Hilibrand, MD, MBA
Treasurer
David A. Halsey, MD
Past President
Robert M. Orfaly, MD
Chair BOC
Thomas S. Muzzonigro, MD
Chair-Elect BOC
Wayne A. Johnson, MD
Secretary BOC
Dirk H. Alander, MD, MHA
Chair BOS
C. Craig Satterlee, MD
Chair-Elect BOS
Kevin D. Plancher, MD, MPH, MS
Secretary BOS
James J. Balaschak
Lay Member
Rachel Y. Goldstein, MD
Member at Large
James R. Ficke, MD
Member at Large
Elizabeth G. Matzkin, MD
Member at Large
Thomas W. Throckmorton, MD
Member at Large
Thomas E. Arend, Jr., Esq., CAE
Ex-Officio
Staff
American Academy of Orthopaedic Surgeons
Anna Salt Troise, MBA, Chief Education Strategist
Hans Koelsch, PhD, Director, Publishing Partner Relationships
Lisa Claxton Moore, Senior Manager, Editorial
Steven Kellert, Senior Editor
Wolters Kluwer Health
Brian Brown, Director, Medical Practice
Stacey Sebring, Senior Development Editor
Kerry McShane, Senior Editorial Coordinator
Erin Cantino, Portfolio Marketing Manager
David Saltzberg, Production Project Manager
Stephen Druding, Design Coordinator
Beth Welsh, Senior Manufacturing Coordinator
TNQ Technologies, Prepress Vendor
The material presented in the Orthopaedic Basic Science, Fifth Edition has been made available by the American Academy
of Orthopaedic Surgeons for educational purposes only. This material is not intended to present the only, or necessarily best,
methods or procedures for the medical situations discussed, but rather is intended to represent an approach, view, statement,
or opinion of the author(s) or producer(s), which may be helpful to others who face similar situations. Some drugs or
medical devices demonstrated in Academy courses or described in Academy print or electronic publications have not been
cleared by the Food and Drug Administration (FDA) or have been cleared for specific uses only. The FDA has stated that it
is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in
clinical practice. Furthermore, any statements about commercial products are solely the opinion(s) of the author(s) and do
not represent an Academy endorsement or evaluation of these products. These statements may not be used in advertising or
for any commercial purpose.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form,
or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the
publisher.
ISBN 978-1-9751-4816-4
Library of Congress Control Number: Cataloging in Publication data available on request from publisher.
Printed in China
Published 2021 by theAmerican Academy of Orthopaedic Surgeons
9400 West Higgins Road
Rosemont, Illinois 60018
Copyright 2021 by the American Academy of Orthopaedic Surgeons
Acknowledgments
Editorial Board Orthopaedic Basic Science 5
Editors
Roy K. Aaron, MD
Professor, Orthopedic Surgery
Professor, Molecular Pharmacology, Physiology, and Biotechnology
Warren Alpert Medical School of Brown University
Providence, Rhode Island
Section Reviewers
Kevin C. Baker, PhD (Basic Disciplines in Orthopaedic Surgery)
Director, Orthopaedic Research
Department of Orthopaedic Surgery
Beaumont Health
Royal Oak, Michigan
Joshua J. Jacobs, MD (Basic Disciplines in Orthopaedic Surgery)
William A. Hark, MD/Susanne G. Swift Professor and Chairman, Department of Orthopaedic Surgery
Vice Provost for Research
Rush University
Chicago, Illinois
Linda J. Sandell, PhD, C-IAYT (Structure and Function of Musculoskeletal Tissues)
Editor in Chief, Journal of Orthopaedic Research
Professor Emerita, Department of Orthopaedic Surgery
Washington University
St. Louis, Missouri
Robert H. Brophy, MD (Pathophysiology and Orthopaedic Medicine)
Professor
Department of Orthopaedic Surgery
Washington University School of Medicine
St. Louis, Missouri
Robert L. Sah, MD, ScD (Repair and Regeneration)
Professor
Department of Bioengineering
University of California, San Diego
La Jolla, California
Barbara D. Boyan, PhD (Repair and Regeneration)
Professor, Department of Biomedical Engineering
Alice T. and William H. Goodwin, Jr. Dean
College of Engineering
Virginia Commonwealth University
Richmond, Virginia
Kurt P. Spindler, MD (Principles of Clinical Information)
Vice-Chair of Research Orthopaedic and Rheumatology Professor, Orthopaedic Surgery
Cleveland Clinic
Cleveland, Ohio
Patricia D. Franklin, MD, MBA, MPH (Principles of Clinical Information)
Professor and Co-Director, Outcomes and Measurement Hub
Department of Medical Social Sciences
Northwestern University Feinberg School of Medicine
Chicago, Illinois
We want to thank Ms. Jennifer Racine-Avila for her editorial and graphics guidance and digital support. Her contributions
to this edition were invaluable.
Contributors
Roy K. Aaron MD
Professor, Orthopedic Surgery,Professor, Molecular Pharmacology, Physiology, and Biotechnology,Warren Alpert Medical
School of Brown University,Providence, Rhode Island
Kristen Allen BS, RAC
Engagement Partner,Quality and Regulatory Affairs,Bruder Consulting & Venture Group,Franklin Lakes, New Jersey
Tamara Alliston PhD
Professor,Department of Orthopaedic Surgery,University of California, San Francisco,San Francisco, California
Thomas P. Andriacchi PhD
Professor (Emeritus)Department of Mechanical Engineering Stanford UniversityStanford, California
Hiba K. Anis MD
Research Fellow,Department of Orthopaedic Surgery,Cleveland Clinic Foundation,Cleveland, Ohio
Valentin Antoci Jr MD, PhD
Director, Outpatient Adult Reconstruction,Assistant Professor of Orthopedic Surgery,Department of Orthopedic
Surgery,Warren Alpert Medical School of Brown University,Providence, Rhode Island
Gerard A. Ateshian PhD
Andrew Walz Professor of Mechanical Engineering,Professor of Biomedical Engineering,Department of Mechanical
Engineering,Columbia University,New York, New York
Karsyn N. Bailey BS
MD/PhD Candidate,UC Berkeley - UCSF Graduate Program in Bioengineering,University of California, San Francisco,San
Francisco, California
Spencer Bailey BS, MBA
Engagement Partner,Reimbursement and Health Economics,Bruder Consulting & Venture Group,Franklin Lakes, New
Jersey
Keith D. Baldwin MD, MSPT, MPH
Associate Professor,Department of Othopedic Surgery,University of Pennsylvania,Philadelphia, Pennsylvania
Alexander M. Ballatori BS
Research Study Coordinator,Department of Orthopaedic Surgery,University of California, San Francisco,San Francisco,
California
Joel A. Block MD
The Willard L. Wood, MD Professor,Director, Division of Rheumatology,Rush Medical College,Rush University Medical
Center,Chicago, Illinois
Barbara D. Boyan PhD
Professor, Department of Biomedical EngineeringAlice T. and William H. Goodwin, Jr. DeanCollege of EngineeringVirginia
Commonwealth UniversityRichmond, Virginia
Brendan F. Boyce MBChB
Professor,Department of Pathology and Laboratory Medicine,University of Rochester Medical Center,Rochester, New York
Caroline Boyle BA
Department of Sports Medicine,Hospital for Special Surgery,New York, New York
Kevin J. Bozic MD, MBA
Professor and Chair,Department of Surgery and Perioperative Care,Dell Medical School at The University of Texas at
Austin,Austin, Texas
Robert H. Brophy MD
Professor, Department of Orthopaedic Surgery,Washington University School of Medicine,St. Louis, Missouri
Scott P. Bruder MD, PhD
Founder and CEO,Bruder Consulting & Venture Group,Franklin Lakes, New Jersey
David B. Burr PhD
Distinguished Professor Emeritus,Department of Anatomy, Cell Biology, and Physiology,Indiana University School of
Medicine,Department of Biomedical Engineering,Indiana University-Purdue University, Indianapolis (IUPUI),Indianapolis,
Indiana
William A. Cantrell BS
Medical Student, Orthopaedic Surgery,Department of Surgery,Cleveland Clinic,Cleveland, Ohio
Arthur L. Caplan PhD
Drs. William F. and Virginia Connolly Mitty Professor of Bioethics,Department of Population Health,NYU School of
Medicine,NYU Langone Health,New York, New York
Andrew K. Chan MD
Resident Physician,Department of Neurological Surgery,University of California, San Francisco,San Francisco, California
Qian Chen PhD
Michael G. Ehrlich, MD Professor of Orthopaedic Research,Department of Orthopaedics,Warren Alpert Medical School of
Brown University,Rhode Island Hospital,Providence, Rhode Island
George J. Christ PhD
Professor of Biomedical Engineering and Orthopaedic Surgery, Mary Muilenberg Stamp Professor of Orthopaedic Research,
Director of Basic and Translational Research in Orthopaedic Surgery, Co-Director, Center for Advanced Biomanufacturing,
Laboratory of Regenerative Therapeutics, University of Virginia, Virginia, Charlottesville, Virginia
Margaret E. Cooke MD
Hand and Upper Extremity Surgery Fellow, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York,
New York
Alexus M. Cooper BS
Research Fellow,Rothman Orthopaedic Institute,Thomas Jefferson University,Philadelphia, Pennsylvania
Matthew M. Counihan MD
Orthopaedic Surgery Resident,Department of Orthopaedic Surgery,University of Pennsylvania,Philadelphia, Pennsylvania
Joseph O. Ehiorobo MD
Research Fellow,Department of Orthopaedic Surgery,Northwell Health,New York, New York
Jennifer C. Erhart-Hledik PhD
InstructorDepartment of Orthopaedic Surgery Stanford UniversityStanford, California
Andrew R. Evans MD, FACS
Assistant Professor of Orthopedic Surgery,Department of Orthopedic Surgery,Warren Alpert Medical School of Brown
