Technique for Arthroscopic Replacement of Severely Damaged Rotator Cuff Using “GraftJacket” Allograft

Abstract

Massive non-repairable injuries to the rotator cuff are a difficult problem to treat. Current methods include tendon transfers and reverse total joint replacement, both procedures have many drawbacks especially in the young patient. The use of a reliable acellular allograft scaffold material derived from freeze-dried human dermis called GraftJacket (Wright Medical Technology, Arlington, TN) has demonstrated promise in a small consecutive group of patients when inserted under arthroscopic control in our prospective study. The pre-clinical work in both the animal and laboratory settings, as well as human biopsies, demonstrates that this unique scaffold will attract host stem cell, offers binding sites for them, and supports their re-growth into a viable tendon-like tissue. The GraftJacket is also rapidly revascularized and attached to the surrounding host tissue including bone, tendon, and muscle. All study patients were evaluated with pre and post op MRI scans and followed clinically for at least a year. The arthroscopic technique for insertion of the GraftJacket allograft has been refined and is now performed in a reasonable surgical time using standard equipment. This paper reviews the SCOI technique and post op care and suggests further areas of study to define the role of this promising material in the future.