How Endurance Athletes Can Play Forever

A healthy joint with good biomechanics is built to last a lifetime. However, once injury occurs, unstable or damaged joints will deteriorate faster than healthy ones.

This makes endurance athletes with injuries—like ultra runners and triathletes who subject their joints to repetitive motion over prolonged periods—particularly susceptible to osteoarthritis (OA).

Outdated approaches have resulted in millions of people walking around with deformed joints, in severe pain, unable to participate in the activities they love. However, people can potentially avoid post-traumatic arthritis and remain active if the damaged tissues are repaired, regrown, or replaced immediately after an injury and restore injured joints if the damaged tissues are replaced with donor biologic tissues.

Even after arthritis has set in (as long as there is still some space preserved between the bones) biologic joint replacement often returns athletes to competitive sports—including running. In this BioKnee® technique, the meniscus and ligaments are replaced with donor tissue, and the articular cartilage is repaired. We almost always prefer a biologic joint replacement to an artificial one, as the biologic knee feels more normal and can always be revised to an artificial one at a later date.

When the knee joint is worn down to bone-on-bone, a partial or full knee replacement is usually required. With the advances in robotic technology and 3D modeling, these are now outpatient procedures with high accuracy and durable materials. For full joint replacement, the accuracy is so high that the need for bone cement is often eliminated: The body grows its own bone into the porous undersurface of the implants, fixing them permanently to each other. These advances combined with personalized guidance from skilled trainers and physical therapists can help injured athletes make a full return to sports. 

Arthritis, once a scourge of active people, need no longer compromise their lives. Surgeons and patients can work together to prevent, treat, and cure post-traumatic arthritis— giving patients the opportunity to come back fitter, faster, and stronger® than they were before they were injured.

Below are experiences of endurance athlete-patients of The Stone Clinic and educational resources produced by orthopaedic surgeon and author of Play Forever: How to Recover from Injury & Thrive Kevin R. Stone, MD. We hope they inspire and empower you to be an athlete for life. 

Articles for Endurance Athletes from The Stone Clinic Blog

Described as a "gift to his patients" Dr. Kevin Stone writes a weekly column guiding athletes with the latest expert insight on sports, performance, & orthopaedic care. Here are some select articles most helpful to endurance athletes. 

Running After Knee Replacement

Running After Knee Replacement

Runners are addicted athletes. Even casual runners love the feeling and the benefits of the sport. When osteoarthritis gets so bad that a joint replacement is considered, the prospect of giving it up is one reason so many runners delay the procedure. But here’s what they don’t know: You don’t have to give it up.

Alternative for Knee Replacement for Runners

Running After Biologic Knee Replacement

Biologic knee replacement involves replacing and regrowing the key structures of the knee joint. Patients choose this procedure to avoid artificial joint replacement and they often plan to return to high-intensity exercise. Here is the latest thinking on how to keep running on the knee’s natural tissues.

Alternative for Knee Replacement for Runners

Thoughts about Endurance Athletes

Running across America goes far beyond what most people do in their sporting life. Richard Donovan did it the year after having both of his knees partially replaced. In this interview with Jeff Greenwald, Dr. Kevin Stone discusses some approaches to the care of endurance athletes.

New Treatments for Arthritis

Don't Go Home & Rest: Personal Strategies for Arthritis Care

“Go home and rest. Wait for your joint replacement. Take ibuprofen. Then, after your procedure, rest some more. Walk, but don’t exercise too much. Don’t wear it out.” These out-of-date responses to arthritic joint pain are flat-out wrong.

Download a Guide to our Knee-Saving Procedures
Explore all your options. Learn about procedures that can help you return to sports & delay or avoid an artificial knee replacement.

Our Endurance Athlete Patient Stories

Hear directly from patients who've undergone our treatment to safely return to their favorite activities. With world-class surgery and dedication to the specialized StoneFit rehab program, these patients provide proof and inspiration of what life after injury can be. 


Watch Our Endurance Athlete Stories

Dr. Jim Taylor

Dr. Jim Taylor - Stone Clinic Escape from Alcatraz 2023 participant, triathlete, and physical therapy patient 

Dr. Jim Taylor, Ph.D., a sports psychologist and avid triathlon competitor, will be racing the 2023 Escape from Alcatraz Triathlon on behalf of The Stone Clinic. Jim recently enjoyed success at the World Triathlon Championships in Abu Dhabi. The event marked the culmination of a long, challenging triathlon season after an injury recovery from a hit-and-run collision while cycling.

Dr. Taylor attributes his achievements to the invaluable support of The Stone Clinic, "The Stone Clinic's knowledge, expertise, and experience, along with their dedicated team, kept me hopeful and helped me become healthy and pain-free. I am forever indebted to Dr. Stone and Shannon for their unwavering support throughout my triathlon season, which ultimately led to my World Championship successes."

Ironman after Knee Surgery

Emily Salmons - Ironman veteran and 13-year post-op BioKnee® patient

"Here's me celebrating 10 Ironman finishes this past September. Seven of those have been since my 2010 (BioKnee) surgery. Hoping I can keep on rolling. Thanks to Dr. Stone for all he did (and still does), keeping headcases like me out there doing things! Still skiing, too!

- Emily Salmons

Triathlon after Knee Surgery

Andrea "Andie" H. - Triathlete and BioKnee® & clavicle repair patient

“Before my articular cartilage procedure, my knee was incredibly unreliable. It would frequently "catch," causing me intense pain. Determined to find the least invasive and most advanced treatment, I conducted thorough research and discovered Dr. Stone's BioKnee program.

After diligently adhering to the post-surgery protocol for a few months, I regained the ability to walk, ride my bike, run, and fully engage in my active lifestyle. My mobility has been completely restored, enabling me to partake in triathlons, backpacking, swimming, rock climbing, mountain biking, and countless other of my favorite activities.

-Andie H. 

Marathon After Knee Surgery

Samantha B. - Marathon runner and BioKnee patient

Samantha B. lived with knee pain since 2013. As a college-level soccer player, Samantha needed a solution to her knee pain so she could perform on the soccer field at full capacity. In 2021, as part of his BioKnee® program Dr. Stone performed a meniscus allograft transplant and articular cartilage paste graft on her knee. Samantha began playing soccer again just three months after surgery and ran her first marathon seven months later. 

John G. IronMan Swim Triathlete

John G. - Articular cartilage paste graft patient and Iron Man Triathlete

After experiencing unsuccessful knee treatments worldwide, John traveled from Australia 🇦🇺 to our Clinic looking to "prove to the rest of the world that I can actually do an IronMan faster than I did before."

And prove it, he did. At the age of 49, John achieved a personal best in the Western Australia IronMan 70.3 competition after a successful articular cartilage paste graft procedure.

Our Programs

BioKnee: An Alternative to Knee Replacement

Heal biologically. If you are looking for an alternative to a total knee replacement, consider our BioKnee® program which rebuilds knees without the use of artificial implants.

The BioKnee program combines Dr. Kevin Stone's most innovative surgical procedures to create a revolutionary treatment for arthritis. The program has permitted hundreds of people with moderate to severe arthritis to stay active and delay or avoid a total knee replacement. 

Learn about our BioKnee®program 

Kevin R. Stone, MD is one of the world’s leading experts in meniscus transplantation and a pioneer of biologic orthopaedic techniques.

For over 30 years, he and his team have specialized in giving people back their vital meniscus shock absorbers, keeping the knee moving naturally and reducing the likelihood of a total knee replacement.

Learn about the Meniscus Transplant Center 

The Robotic Joint Center at The Stone Clinic is an international destination for robotic-assisted surgery for athletic total and partial knee replacement.

We have patients now running triathlons and (ultra)marathons, climbing mountains, skiing a hundred days a year on the replaced parts inside their knees. The groundbreaking innovations in robotic surgery are redefining the limits of our athletes and expanding the expectations of what is possible after knee replacement.

Learn about the Robotic Joint Center

If you are looking for an alternative to an ankle fusion or ankle replacement procedure, consider our BioAnkle® which biologically rebuilds injured and arthritic ankles without the use of artificial implants, plates, or screws. 

Learn about our BioAnkle® program 

More Resources

We’ve recorded hundreds of videos to help you protect your joints and play forever. Our library contains overviews of our biologic treatments, patient recovery stories, injury prevention advice, fitness & performance tips, and much more. 

Explore our Videos 

Described as a "gift to his patients" this short, weekly column written by Dr. Stone provides the latest expert insight on sports, performance, & orthopaedic care.

Explore Dr. Stone's Blogs

If you’re not sure what might be wrong with your joint, our self-diagnosis tool for the knee, shoulder, and ankle is a good place to start. It won’t replace a real doctor and cannot give a definitive diagnosis but it may help you better understand your symptoms.

Understand your injury with our Symptom Checker 

Dr. Stone developed these joint-saving guides to help you preserve your natural tissues and extend your active life. 

Download the Saving My Ankle Guide Here

Download the Saving My Knee Guide Here

Download the Saving My Shoulder Guide Here

Experienced & Skilled Surgeon: Kevin R. Stone, MD
Pioneering Surgeon: Kevin R. Stone, MD
Dr. Stone is an orthopaedic surgeon at The Stone Clinic & the chairman of the Stone Research Foundation. He was trained at Harvard University in internal medicine and orthopaedic surgery and at Stanford University in general surgery.

World-renowned orthopaedic surgeon, Kevin R. Stone, MD, leads the clinic. Dr. Stone is one of the world’s leading experts in meniscus transplantation and a pioneer of biologic orthopaedic techniques. For over 30 years, he and his team have specialized in giving people back their vital meniscus shock absorbers at The Meniscus Transplant Center. Dr. Stone is also a leader in outpatient robotic surgery for partial and total knee replacement and is consistently recognized as the country’s top 75 knee surgeons7.

He is a physician for Smuin Ballet and has served as a physician for the U.S. Ski Team, the U.S. Pro Ski Tour, Lawrence Pech Dance Company, Marin Ballet, and for the United States Olympic Training Center. He's been featured on Good Morning America, the Ologies podcast, and Neal deGrasse Tyson's Star Talk podcast. He is also the best-selling author of the book Play Forever

Kevin R. Stone, MD Harvard
Kevin R. Stone, MD Stanford
Kevin R. Stone, MD GMA
Kevin R. Stone, MD TED Talk