What is Core Muscle Repair?
Core muscle repair is a surgical procedure used to treat core muscle injuries, also known as sports hernia or athletic pubalgia. It involves suturing the healthy ends of the torn or damaged core muscles in the abdomen, typically the rectus abdominis.
Sometimes your surgeon may additionally perform an adductor tenotomy for any of the following reasons:
- To treat pain in the inner thigh following core muscle repair surgery
- For added stability
- To prevent tear and hernia recurrence
In an adductor tenotomy, your inner thigh muscle, or adductor longus, is released by cutting the tendinous portion of the adductor longus that is attached to the pubis.
Core muscle repair is primarily recommended for athletes who are involved in sports activities that involve intense twisting and repetitive motion such as soccer, basketball, hockey, running, and football. It is more commonly performed in males, as males are more prone to core muscle injuries during sports.
What are the Indications for Core Muscle Repair?
Core muscle repair is recommended for the treatment of athletic pubalgia or sports hernia. You are a candidate for core muscle repair if you have:
- A core muscle injury such as a grade 3 or complete tear of the rectus abdominis muscle that cannot be treated through conservative approaches
- A severe core muscle injury that requires immediate attention
Other indications may include:
- Severe trauma
- An abdominal hernia
- To repair a post-pregnancy defect in the rectus abdominis muscle where there is loosening, weakening, displacement, or separation of the muscle wall
Core Muscle Repair Procedure
Core muscle repair can be performed either through an open approach or via endoscopy. The common steps for the surgical procedure are:
- You are placed on the operating table in the supine position (on your back).
- The choice of either local or general anesthesia is decided by the surgeon based on the candidate’s age, overall health, and medical history.
- The incision site is identified and marked.
In this technique, your surgeon makes a single long incision measuring about 5-10 cm to view and access the surgical site.
- Your surgeon retracts the groin muscles to access the area that is damaged.
- The healthy ends of the muscle fibers, usually the lower end of the rectus abdominis, are sutured.
- A synthetic mesh may be placed and sewn over the damaged area to provide extra strength and support.
- Your surgeon sutures the incision in the abdominal wall.
Endoscopic or the Minimally Invasive Surgery
In an endoscopic core muscle repair, one or more small incisions are made in the marked site.
- Through the incisions, the endoscope and other surgical instruments are inserted. The endoscope is a long, thin, flexible tube with a tiny video camera and light at its end.
- Based on the images generated by the endoscope, the torn muscle is identified and repaired through one of the following approaches:
- By stitching/suturing its healthy ends together
- A procedure called inguinal neurectomy may also be performed if your surgeon finds that the small inguinal nerve in the groin is injured or scarred. The inguinal nerve is severed during the surgery to relieve pain.
- Additionally, adductor tenotomy may be performed, where the tendon attaching your inner thigh muscle to the pubis is cut.
- After the core muscle has been repaired, the incision is closed using either non-absorbable or dissolvable sutures.
Recovery and Post-Surgical Care
You will be discharged the same day as your core muscle repair. Ensure that you have someone to drive you home as the anesthesia and pain medications can make you drowsy.
The general post-surgical care instructions include:
- You may experience pain, swelling, numbness, or weakness in or around the operated region. Your surgeon will give you medications to provide relief.
- As it is not a major surgery, you should be able to walk within a day after the procedure.
- Keep the incision site clean and dry.
- Your surgeon will give you self-care instructions which include diet, wound, and bathing care.
- You can resume your daily activities slowly. Strenuous activities should be avoided until consultation with your surgeon.
- Complete recovery may take 3- 8 weeks or even longer, depending upon the severity of the injury and surgery performed.
Recovery from the endoscopic procedure is quicker than with open surgery. The other benefits of keyhole surgery may include:
- Smaller scar
- Less pain
- Less risk of infection
What are the Risks and Complications of Core Muscle Repair?
Any surgical procedure involves some amount of risk. Similarly, core muscle repair may also involve the following risks and complications:
- Formation of blood clots
- Reaction to the anesthesia such as nausea and vomiting
- Injury to surrounding tissues, muscles, or internal organs