Inside the OR: Repairing a core muscle injury

On Tuesday, Chip Kelly confirmed that Eagles star center Jason Kelce underwent surgery to repair a sports hernia resulting from an injury suffered in Sunday's game against the Washington Redskins.

Kelce's surgery was most likely performed by Dr. William C. Meyers at the Vincera Institute in the Philadelphia Navy Yard. Meyers is nationally recognized as a pioneer in the diagnosis, treatment and rehabilitation of core muscle injuries (you won't hear him use the term "sports hernia").

While we don't have specific confirmation that Meyers was the surgeon, it shouldn't come as any surprise if it was him. Meyers has performed more than 18,000 core muscle repair procedures in the past 25 years and his patient list reads like a who's who of professional athletes.

Donovan McNabb, Brent Celek, Adrian Peterson, Danny Briere, Miguel Cabrera and Greg Jennings have visited his operating room, as well as scores of high school and college athletes.

What is it about Meyers' technique that lures the nation's top athletes to Philadelphia?

Most commonly in core muscle injuries, the rectus abdominus or adductor muscles are pulled off of the pubic bone, which causes the athlete pain. Often, these injuries are repaired by placing a cone of mesh into the tear to essentially "plug" the hole formed in the muscle.

However, in the early 1980s, while studying at Duke, Meyers stumbled upon an experiment that led to a new understanding of the injury.

"I was in the lab conducting an experiment on a cadaver," Meyers recalled. "I had a medical student put her fingers under some muscles while I cut them from above, and when I did that, the muscles jilted backwards and pinched her fingers between the bone. She let out a scream and suddenly I realized that the anatomy is a lot different than the way it was originally described. The whole core muscle complex contributes to the injury."

At the time, Meyers was following three basketball players at Duke and performed surgery on them, focusing on repairing the core muscles where he thought the injury was. As you can probably guess, it was successful.

"For years, people weren't even in the ballpark of understanding the anatomy behind these injuries," said Meyers. "This experiment opened us up to a brand-new process of thinking."

The Surgery

Meyers has identified 18 different variations of core muscles injuries, which can range from torn muscles to frayed muscles to a weakness in the abdominal wall. A diagnosis can be difficult because, unlike more common hernias, there is not always a visible bulge in the leg or groin area.

Meyers performs an open procedure in which he exposes the muscle tear and then surgically reattaches the muscle to the pubic bone.

"When you tear one of the attachments, you start to compensate with other muscles," said Meyers. "It just comes down to finding which muscles are torn and which muscles are pulling too tight."

Rehabilitation Process

Rehabilitation from surgery for core muscle injuries is generally three to eight weeks, but can last longer depending upon the severity of the injury and surgery performed.

Typically, patients are expected to be walking one day postoperatively.

"Bill usually starts his patients in rehab the next day with a scar tissue massage," said Dr. John Salvo, who specializes in hip arthroscopy and preservation at Rothman Institute.

Physical therapy generally begins one week post-surgery. At the Vincera Institute, patients enjoy the convenience of physical therapy services located within the facility. Patients work to retrain the core and the rest of the muscles in the area, including the hamstrings, gluteals, and back, to work together more efficiently.

Success Rate

In the 25 years Meyers has been performing these surgeries, he has reported a 95 to 96 percent success rate.

"We measure the success rate by the number of patients who can return to their previous performance level or above following the surgery," said Meyers. "Most of the time, that four or five percent get better but they don't make a full return because other problems, like those in the hip, start to creep in."

Read more Sports Doc for Sports Medicine and Fitness.