Recently, growing attention has been given to the fact that some types of surgery may be overrated. This article succinctly summarizes the situation, citing dozens of studies showing that some orthopedic surgeries popular in past decades had no better results than non-invasive treatments.

This issue is deeply personal to me. In 2020, during the pandemic, I sustained an injury to my left knee, experiencing severe pain, swelling, and loss of motion. An MRI revealed a posterior cruciate ligament (PCL) avulsion fraction of the tibial plateau with a small fragment, a posterior horn medial meniscus tear, and strains to both the anterior and posterior cruciate ligaments (ACL and PCL) with a partial tear to the plantar and popliteus muscles.

An initial evaluation by an orthopedic surgeon determined that surgery was necessary to restore normal function to my knee and resume my regular physical activities, such as long-distance running. However, as a physiatrist, I believed conservative treatment could be effective. Additionally, the uncertainties surrounding hospitalization and surgery during the pandemic played a role in my decision.

Fortunately, I had been involved in studying the building and rebuilding of the body from two angles: that of physiatry and that of bodybuilding. Utilizing this knowledge, I created an exercise program to regain full range of motion and weight-bearing in my injured knee. In the summer of 2022, I successfully ran a high-altitude marathon in Machu Picchu without any complications or restrictions.

The treatment of intra-articular ligament tears requires careful evaluation to determine the best approach. Some cases may indeed require surgery. Neglecting surgery in such instances may lead to long-term consequences, including a higher risk of re-injury and chronic instability. Seeking medical advice and considering all options is crucial before deciding on the most suitable course of action.

Non-surgical treatments have been challenging to study due to their complexity and the time required for completion. More high-quality research is needed to compare these treatments to surgical outcomes for injuries similar to mine. For other injury types, research has indicated a higher risk and lower reward profile for surgery. Therefore, non-surgical interventions should receive more attention if my injury can recover without surgery, and if certain surgeries have been overestimated in their effectiveness.

One area that researchers should explore is the impact of anti-inflammatory diets and lifestyle changes on injury recovery. Personally, I firmly believe in research demonstrating how certain foods can increase or decrease inflammatory markers. During my knee injury and recovery, I took supplements like high-EPA and -DHA fish oil, turmeric, and vitamin D3 with K2. Notably, I did not immediately connect this to my successful healing process.

However, later on, I learned that my son, when seeking treatment for his back pain at a regenerative medicine clinic, was advised to follow an anti-inflammatory diet and supplement regimen for weeks before his visit. They made it clear that they would not proceed with treatment if he did not follow this protocol, as inflammation was deemed a leading cause of treatment failure in their back pain patients. His treatment was effective and relieved his persistent back pain.

On the surface, this approach makes common sense. A growing body of evidence demonstrates that certain foods, which have become increasingly prevalent in American diets in recent decades, contribute to systemic inflammation. We are discovering more mechanisms for this, such as the creation of Specialized Pro-resolving Mediators (SPMs) in response to consuming certain omega-3 fatty acids, and the possibility of an autoimmune response to Neu5G incorporated into our cells due to the consumption of red meat.

As health care providers, our primary goal is to facilitate the healing process for our patients. We employ various treatments, including medications and interventions, to create the optimal environment for recovery. However, when it comes to rehabilitating injuries, we often neglect to consider the impact of diet, despite the well-known adage “you are what you eat.”

It is crucial to recognize that the raw materials for growth and healing in our bodies are derived from the foods we consume. As such, we should place emphasis on understanding our patients’ dietary habits and advising them accordingly. Currently, we tend to address specific dietary regimens only when treating obesity or gastric distress, but we should extend this approach to all patients to promote optimal health and healing.

Have we given up on advising patients on diet because many of them must follow basic recommendations about consuming enough fruits and vegetables? This would be a mistake. Providing specific advice tailored to a particular upcoming medical event may be perceived differently than general advice that everyone should always follow.

Or have we, as medical professionals, neglected the role of nutrition because much of what we are learning about the role of different foods in healing and disease processes is new? The era of molecular medicine has led to the discovery of hundreds, if not thousands, of new biochemical pathways, shedding light on the sometimes-confusing results of diet studies from the last century. However, many of these discoveries have yet to be put into widespread practice in clinical or dietary guidelines.

By shifting back to personalized exercise and dietary regimens for patients facing acute illness and injury, we may observe superior risk-reward profiles compared to what we currently see with surgical interventions alone. Moreover, surgical interventions, with their long list of potential risks and side effects, may prove to be less common than we previously assumed.

In conclusion, the decision to pursue surgical or non-surgical treatment for knee ligament tears should be based on individual circumstances and after consultation with a health care provider. This is precisely why it is incumbent upon us as providers to consider all possible interventions and all available medical knowledge when presenting our patients with their treatment options.

When we recognize that surgery alone has often historically proven to be less than optimal, it becomes essential to investigate all the new science available to us, including increasingly nuanced findings about the effects of food and exercise on our healing processes.

Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness.