Common Surgical Procedures for Muscle Tears & Soft Tissue Tears
If Muscle Surgery is Required...
Surgery may be necessary if you have exhausted all forms conservative treatments, resting, cold, PT - and, you still find yourself in pain and have limited functionality in common daily activities. You and your doctor may decide to move forward and have you undergo surgery, triggering the next chapter of your injury recovery journey. A good point to remember is that your post surgery rehabilitation efforts will have an important impact on how soon you can return to living and enjoying your normal daily life.
The surgery that your surgeon will recommend for you will depend on the level of your pain, the type of injury you have, and the amount of damage there is in the area. Damage is typically determined from your physical exams, x-rays and MRI results. The length of time between the injury and the surgery is often also a determining factor in the type of surgery that will be required.
With acute (recent) tearing, the separation in your tendon / muscle / ligament is likely to be very minimal. If you have an acute tear you may qualify for less invasive surgery (such as a arthroscopic, open surgery or an mini-open procedure). Surgeons will always choose a shorter, less invasive procedure if it is possible to do so. Most surgeons know that a less complicated procedure will have less trauma to the muscle(s), resulting in a quicker rate of recovery after the surgery.
If you are suffering from an acute muscle injury and surgery is needed your surgeon will have you wait up to 72 hours before they'll do the repair to the muscle tissue. This gives your body time for the injury to settle down.
If you have suffered a complete rupture of your muscle from the tendon it is important to have the tissue reattached. The muscle will shrink and you may lose strength or in some cases range of motion loss. Your doctor will advise you to wait at least 48 to 72 hrs after the injury to allow inflammation to be reduced. This is to allow the sutures a better chance of holding in the muscle fibres together for the repair.
If you're in pain why do they make you wait before they repair your muscle injury?
Your body will send a large amount of blood via inflammation to the tissue where the damage is located to start the healing process. Muscle tissue is very soft and squishy to begin with; damage or injury of any kind only further weakens the muscle. The increased blood flow makes the muscle tissue even softer, almost like Jello. During the first few days of injury, the surgeon will have a difficult time sewing your 'jello-like' tissue back together. If the surgeon even tried to do this it's likely that you'd end-up needing more surgery as the procedure to fix your muscle won't hold.
If you've suffered a complete rupture of your muscle it's important to have the tissue reattached. If not the muscle will shrink and you may lose strength, or in some cases, experience a decrease in your range of motion. Your doctor will advise you to treat your injury with cold compression for at least 48 to 72 hrs after the injury to allow the inflammation to be reduced. This must be done before any other treatment or surgery in the area can happen.
The surgery performed to repair soft tissue usually involves one or more of the following surgical goals:
- Debridement - this is the removal of any loose fragments of tendon, bursa, bone or other debris from the area.
- Smoothing - the surgeon makes room so that tendons and muscles can function properly without being pinched (aka impingement). This sometimes results in shaving down of bony edges or spurs from bone so tendons can slide across without fraying. Common examples would be hip, shoulder and heel.
- Stitching - torn tendon edges are sewn back together and reattached to the bone if needed.
Open Muscle Surgery
This is the traditional surgery used when there's a large amount of damage in the area. This could include damage to one or more of the following: muscle, tendon, cartilage, ligaments and/or bone fractures. During this procedure one long incision is made in the area of your muscle injury.
An open incision this large provides enough room for the surgeon to prepare the tissue for repair by re-attaching the torn muscle to the tendon or sewing the torn edges of the muscle together. Non-absorbale sutures are used to bring both sides of the tear together and make sure that the repair is as strong as possible. A small screw/anchor is used to reattach the tendon/muscle back to the bone if the it has been ruptured completely.
Surgeons often use a strong nylon or polyester material to bring the edges of your torn muscle together. They use a locking-loop or three-loop pulley pattern to prevent the muscle tissue from gapping. This also provides the muscle with the 'tension' needed to ensure the muscle heals with stronger fibers. (source: US National of Library of Medicine - PubMed.gov)
An open procedure with precise suturing improves overall strength of your muscle during the recovery process, making it less likely to re-rupture in the future.
Debulking or Debridement of the Muscle Tissue
A debridement is a specific surgical technique where the surgeon removes damaged tissue from the body with the intent of helping the body heal better. Tissue targeted for removal is generally dead, infected or contaminated. As an example, soft tissue can be exposed in the event of an open fracture (a fracture that is exposed outside the body). In such cases, there is typically soft tissue that is contaminated (exposed to outside) and some soft tissue that is so damaged it cannot survive. In such cases, a surgeon will remove this soft tissue so the wound will heal faster and be less prone to infection.
Debridement is often performed during open muscle surgery. To perform a debulking or debridement the surgeon will cut away any damaged/inflamed tissue. If the muscle is ruptured at the tendon, they will also scrape down any calcium deposits (bone spurs) that have formed on the bone. Scar tissue may be removed from the muscle fibers, tendons, tendon sheath surrounding the tissue or from both surfaces.
Debulking or debridement is used as a last resort for chronic muscle conditions if all methods of conservative treatment options have been exhausted.
Mini-Open Muscle Repair
When a surgeon performs a "mini-open" repair, he/she will make one long incision in the skin and/or smaller vertical incisions depending on the area of your muscle injury. These smaller vertical incisions are made with a pair of surgical scissors and are commonly referred to as "stab incisions".
Once the incisions are opened up, the surgeon will place precise sutures in the muscle tissue with non-absorbable stitches to strengthen the damaged muscle tissue. This suturing technique reduces the amount of scar tissue in the muscle after surgery and provides better surface healing of the skin. Unlike the traditional method of an open surgery, this procedure has less risks and complications involved. To learn about all risks you may face be sure to speak to your doctor.
Percutaneous Muscle Surgery
This procedure can be done in 2 ways:
- Via regular (small) incisions
- or, "stab incisions" with a needle
When percutaneous surgery is done using small incisions, the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) in the skin. Small forceps are used to free the soft tissue casing around your damaged muscle to make room for the surgeon to stitch/suture any tears.
As an alternative to the regular (small) incision approach, your surgeon may perform percutaneous surgery by using a surgical needle to repeatedly stab your tight and constricted muscle. These "stab incisions" will allow the surgeon to free up soft tissue that is abnormally tightened up (often from scar tissue), lengthening your muscle. The surgeon will typically enable ultrasound imaging to direct needle placements. This type of muscle surgery has been very successful in providing range of motion improvements. In most cases, the muscle in question has had open surgery with unsuccessful results and a build-up of scar tissue has further tightened the tissue.
As another option - some surgeons will use a combination of the above types, making 1 to 3 incisions for smaller surgical implements to repair soft tissue while relying on imaging ultrasound to see your damaged tissue. During either procedure, the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
Arthroscopic Surgery
Arthroscopy can be a minimally invasive surgical procedure that is used to diagnose and/or treat some conditions. If a doctor is unable to make a diagnosis following a physical exam, x-ray, and/or MRI, an arthroscopy may be performed to get a better look inside the injury area so a diagnosis can be made.
This type of surgery is normally used on joints of the body, like the shoulders or knees. Arthroscopic surgery is usually performed with the patient under general anaesthetic. During surgery, tiny incisions (1/4" - 1/3") are made to insert the surgical instruments, and a thin tube containing a camera and light.
Arthroscopic muscle surgery will provide the surgeon with a first hand look into the nature of the injury and what work must be done to fix the injury. If the damage is not extensive, the surgeon will be able to complete the repair through an arthroscopic procedure. This is a minimally invasive procedure so it may limit the amount muscle tissue damage from surgery, helping promote a more effective recovery.
Stability of The Affected Joint(s) after Muscle Surgery
It is important to understand that surgery may not give you 100% functionality of your joint, but you should be able to return to most if not all of your pre-injury activities.
Surgical procedures (as outlined above) are often performed with very successful results. What truly makes a difference is your commitment to a doctor recommended rehabilitation program after surgery as there is always a possibility of re-injury even after a surgical procedure. One complication of surgical repair for muscle/tendon tear is that skin can become thin at site of incision, and may have limited blood flow.
Ask any doctor and they will tell you that the success of your surgery depends on your level of dedication to your recovery. Most of our post-op clients have experienced positive results through adhering to a dedicated home conservative treatment regimen as oulined in the Muscle Post Surgery Rehab page.
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