Latissimus Dorsi Tendon Transfer with GraftJacket® Augmentation to Increase Tendon Length for an Irreparable Rotator Cuff Tear

Abstract

Massive irreparable rotator cuff tears can be reconstructed with latissimus dorsi tendon transfers (LDTT). Although uncommon, the natural length of the latissimus dorsi tendon (LDT) could be insufficient for transfer even after adequate soft tissue releases. Descriptions of cases where grafts were needed to lengthen the LDT are therefore rare. We located only two reports of the use of an acellular dermal matrix to increase effective tendon length in tendon transfers about the shoulder: (1) GraftJacket patch for a pectoralis major tendon reconstruction and (2) ArthroFlex® patch for LDTT. Both of these brands of allograft patches are obtained from human cadavers. These products are usually used to cover soft tissue repairs and offer supplemental support rather than for increasing tendon length. Extending the LDTT with GraftJacket to achieve adequate length, to our knowledge, has not been reported in the literature. We report the case of a 50-year-old male who had a massive, irreparable left shoulder rotator cuff tear that was reconstructed with a LDTT. The natural length of his LDT was insufficient for transfer. This unexpected situation was rectified by sewing two patches of GraftJacket to the LDT. The patient had greatly improved shoulder function at two-year follow-up.

Augmented latissimus dorsi transfer: initial results in patients with massive irreparable posterosuperior rotator cuff tears

“…There are techniques described in the literature using allograft as a bridging construct in the case of massive and irreparable rotator cuff tears. 1,2,8 However, in the case of LDT, although a case report exists, 16 no long-term follow-up results have been reported. 16 There are limitations to the present study, including its retrospective nature with incomplete data, lacking randomization and comparison with a control group.…”

“…1,2,8 However, in the case of LDT, although a case report exists, 16 no long-term follow-up results have been reported. 16 There are limitations to the present study, including its retrospective nature with incomplete data, lacking randomization and comparison with a control group. Although important for the selection of surgical candidates with regard to their postoperative rehabilitation compliance, the pre-operative increase in range of motion by performing standard physiotherapy may be a source of selection bias.…”

“…Acellular dermal allografts can be used to cover and reinforce soft tissue repairs. 16 We report the outcomes of LDT augmented with an ADA as a bursal-sided onlay. The purpose of the modification of the LDT procedure in the present study was not only to augment the native latissimus tendon and improve its tensile properties during the healing process, but also to act as a denervated barrier to reduce subacromial impingement pain.…”

Bioinspired materials and tissue engineering approaches applied to the regeneration of musculoskeletal tissues

“…Moreover, commercial biological or synthetic substitutes have been reported in clinical applications. These scaffolds derived from human acellular tissue GraftJacket [127,128] or from bovine (TissueMend, OrthoMend, and BioBlanket) and porcine dermis (Restore and Zimmer Patch) have a rich collagenous matrix and have been used for the reinforcement of soft tissues. Examples of synthetic substitutes include Ligament LARS [129], revised by Batty et al [130].…”

How to Use a Graft in Irreparable Rotator Cuff Tears: A Literature Review Update of Interposition and Superior Capsule Reconstruction Techniques

“…Only human, clinical studies, in the English language were included. Using these parameters, a total of 19 relevant results that pertain to IG in massive or irreparable RCT were returned [9, 11, 14, [37] and one strictly surgical technique paper [36]. The majority of articles returned were reviews that explored various repair options and outcomes that included massive and irreparable RCT [9,11,14,[29][30][31][32][33][34][35]38].…”