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.
Highlights
Massive irreparable rotator cuff tears can be reconstructed with latissimus dorsi tendon transfers (LDTT) (Figures 1(a) and 1(b))
Sometimes the teres major tendon is transferred in addition to the latissimus dorsi tendon (LDT) in order to obtain better external rotation of the shoulder [4, 5]
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
Summary
Massive irreparable rotator cuff tears can be reconstructed with latissimus dorsi tendon transfers (LDTT) (Figures 1(a) and 1(b)). Case Reports in Orthopedics matrix allograft patches to extend rotator cuff tears that had insufficient length for repair is well described [15,16,17]. The patch used in that case was a 3 mm ArthroFlex patch (a brand of human acellular dermal matrix) This product is usually used to cover soft tissue repairs and offer supplemental support rather than for increasing their length [16, 18, 19]. Extending the LDTT with an alternative common acellular dermal matrix (GraftJacket) to achieve adequate length, to our knowledge, has not been reported in the literature. This yielded greatly improved shoulder function at two-year follow-up
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