Surgical Treatment

If conservative measures are unsuccessful, surgery to repair a core muscle injury may be required.  Early surgical intervention of severe core muscle injuries may return players to full play very quickly and at high performance levels.   Depending on the athlete's syndrome and its severity, a specific surgical plan will be developed.  This plan could be one of 121 different combinations of surgeries.

Similar to reconstruction of the knee, surgical intervention for core injuries entails re-suturing the attachments down to the bone and adjacent ligaments in order to provide stability to that pubis joint.  The precision of the angle at which the tissue is distracted, and then re-joined, is important with respect to the success of this operation. 

Dr. Meyers performs an open surgical procedure (pelvic floor repair), which consists of the surgical reattachment of the rectus abdominis muscle to the pubis.  If the athlete has adductor symptoms, which is most likely due to a secondary chronic inflammatory process, an adductor compartment release is performed.  This release consists of the anterior and lateral release of the epimysium of the adductor fascia.  This surgical treatment is effective because it directly treats the likely underlying pathology. 

Athletes must ensure that the surgeon who will be performing the surgery is versed in the variants and the 121 combination of procedures, performs the open method with the adductor compartment releases, operates on a large number of patients with these injuries, and has a high success rate. 

Laparoscopic surgery is not recommended since it fails to treat the underlying problem nor does it address the adductor
issues.  The laparoscopic repair emphasizes a "tension free" mesh insertion; however, this does not stabilize the anterior pelvis.  In selected patients, however, laparoscopic surgery does have a role for the treatment of true hernias.

 
WHAT TO EXPECT IF YOU ARE HAVING SURGERY

Preadmission Testing

If you do have surgery, we comply with all of the surgical center’s requirements related to pre-operative testing since you will receive general anesthesia during your procedure.  If you are in good health, under the age of 50, and have no underlying cardiac, pulmonary or other major health problems, you will not require testing.  If you are over the age of 50, you will be required to have blood work and an EKG prior to your surgical procedure. 

If a surgical procedure is planned, you will be admitted to the surgery center on the morning of that surgery.  You will have the opportunity to speak to a member of the anesthesiology staff at the time of admission and will be asked to sign a surgical consent form for the facility.  Once the procedure is complete, you will be transported from the operating room to the recovery room until you have satisfactorily awakened from general anesthesia.  You will be discharged home or to your hotel a few hours after the surgery.  In order to be discharged from the surgical center, you must be accompanied by an adult.   

 
You will be given a prescription for pain medication which you should use as needed. 

 

Post-operative

You should plan on having someone else drive for you for approximately one week or longer if you continue to require pain medication.  You can resume sexual activity immediately as long as you are careful to avoid extremely strenuous exertion.  Activities of daily living are performed as tolerated.

 

You will be instructed to have your surgical incisions checked one week after surgery.  You will have no stitches to be removed – steri-strips are applied and they will fall off.  Call our office to let us know how you are feeling.  You will be asked to call back again when you are mid-point in the rehabilitation process in order to let us know how you are progressing.  We require that you call back to the office seven days and seven weeks post-operative. You need to have a surgeon check your incision prior to the phone call on the seventh post-operative.  If you live in the general area, you will be given a post-operative appointment in our clinic, but we do not expect that you travel a great distance for a routine post-operative visit. 

Post-Operative Questions

If you have any questions or concerns, please feel free to call the office at any time.  If you develop an acute symptom or concern, please see a local physician, go to the emergency room or call 911 and request that your physician call the office to speak directly with Dr. Meyers.