Surgical treatment of muscle injury. A review of current literature and indications

Abstract

Introduction. Muscles lesions are common sport-related injuries. They are usually treat-ed conservatively with good outcomes. However, large structural muscle injuries (type 4 according to I.S.Mu.L.T. classification) are a challenge for physicians. Often, patients may suffer from discomfort and residual pain, functional impairment, and the rate of complications and re-injury rate is high. Furthermore, the lack of clear indications does not help physicians in the decision process. Methods. We performed a systematic review of four databases (PubMed, Google scholar, EMBASE, Cochrane Library) using the Preferred Reporting Items for Systematic reviews and Metanalysis (PRISMA) guidelines. Level I (RCT), II, III and level IV studies (case series) were included. We also searched for biomechanical and animal studies. Results. Surgical repair of type IV muscle injuries seems to provide better outcomes and higher rate to return to sport than conservative treatment, although surgical repair is not supported by level I or II studies. The suture of the muscle fibers together with the epimy-sium increases the mechanical resistance of the suture and reduces the risk of pull-out. This technique allows earlier mobilization, promotes healing and reduces scar formation. Conclusions. In this article, we try to explain the rational to suture a closed muscle tear, summarize the proper surgical indications, and show the proper suture technique.