Surgery induces a significant catabolic stress response that challenges physiologic reserve. Inflammatory, hormonal, and metabolic pathways are activated to prioritize survival leading to increased energy expenditure, accelerated skeletal muscle proteolysis, and transient insulin resistance. The clinical consequence is postoperative weakness, muscle loss, and delayed recovery, effects that are particularly pronounced in older adults and in athletic, high-demand patients.1,2

Nutritional optimization offers a unique preoperative opportunity to enhance a patient’s metabolic reserve, thereby better preparing them to withstand the physiological stress of surgery (Figure 1).3

Enhancing preoperative metabolic reserve can attenuate the postoperative catabolic response, fostering a more anabolic environment that supports early healing and strength recovery, while promoting sustained long-term functional outcomes.3

Nutritional status is a key determinant of surgical recovery.4 Deficiencies in protein intake, essential amino acids, and micronutrients such as vitamin D are prevalent even in otherwise healthy orthopedic patients and correlate with impaired collagen synthesis, poor tendon quality, and higher complication rates.2

Metabolic prehabilitation, the deliberate optimization of nutritional status has been shown to attenuate catabolic decline and improve postoperative strength and healing trajectories.5 This review integrates insights from orthopedic metabolic science and performance nutrition to outline a framework for perioperative optimization. It emphasizes practical strategies for preoperative screening, targeted supplementation, and metabolic support aimed at improving surgical outcomes in procedures such as Anterior Cruciate Ligament (ACL) reconstruction and rotator cuff repair.