Creatine Supplementation in Pediatric Orthopedic Rehabilitation: A Translational Review and Proposed Clinical Trial Framework.

Introduction: Knee arthroscopy is a commonly performed minimally invasive orthopedic procedure in pediatric and adolescent populations, particularly for sports-related injuries such as ligament tears and meniscal pathology. Optimization of post-operative recovery is essential in this age group to preserve muscle mass, restore neuromuscular control, and facilitate safe return to activity during a critical period of musculoskeletal development. Perioperative nutritional strategies represent a modifiable adjunct to rehabilitation; however, their role in pediatric orthopedic recovery remains insufficiently defined. Materials and Methods: This comprehensive narrative review synthesizes mechanistic, translational, and clinical literature on creatine supplementation to evaluate its potential role in enhancing post-operative recovery following pediatric and adolescent knee arthroscopy. Relevant literature was identified through structured searches of PubMed, Scopus, and Google Scholar, emphasizing adult orthopedic rehabilitation trials, experimental studies of skeletal muscle metabolism, perioperative nutrition research, and limited pediatric supplementation data. Although not conducted as a formal systematic review, a structured and targeted search strategy was used to enhance methodological rigor and reproducibility. Results: Across adult surgical and immobilization models, creatine supplementation has demonstrated preservation of muscle mass, enhanced strength recovery, improved GLUT4-mediated glucose uptake, augmented glycogen storage, reduced inflammatory signaling, and attenuation of disuse-related muscle atrophy. Although direct pediatric surgical data are lacking, consistent mechanistic and clinical findings, combined with creatine's endogenous production and favorable safety profile in youth athletic populations, provide a biologically plausible rationale for investigation in pediatric orthopedic settings. Conclusion: The convergence of adult evidence and the absence of pediatric-specific clinical trials highlights a critical gap in the literature. Creatine supplementation represents a promising adjunct to post-operative rehabilitation following pediatric knee arthroscopy, warranting prospective clinical trials to determine its efficacy, safety, and optimal perioperative use.