Acellular Dermal Matrix Reconstruction of Rotator Cuff (Graft Jacket)

Graft jacket is a regenerative tissue product developed from human skin (consisting of collagen and elastic fibres) and is used for initiating the process of regrowth of damaged tissue.

The graft consists of collagen and elastic fibres of the skin and preserved blood vessels, from which all the cells and moisture have been removed. These components provide a favourable environment for regeneration and healing of the damaged tissue.

Indications and Contraindications

Graft jacket can be used in the following conditions:

  • Tendon (tissue connecting muscle to bone) repair augmentation of rotator cuff tears (tearing of muscles and tendons that keep the shoulder in its place) and ruptured calcaneal tendons (tendons at the back of the heel)
  • Diabetic foot ulcers
  • Ligament (tissue connecting bone to bone) repair and augmentation Graft jacket is contraindicated in the following conditions:
  • Autoimmune connective tissue diseases
  • Infected or nonvascular (lacking blood vessels) surgical sites
  • Presence of factors that could limit blood supply and hamper healing
  • Poor nutrition and general medical condition
  • Specific antibiotic sensitivity

Use of Graft jacket in large rotator cuff tears

Graft jacket is recommended in large rotator cuff tears (usually greater than 3 cm) or after failure of the traditional rotator cuff surgery.


A two-stage procedure is involved in implanting the Graft jacket for rotator cuff tears. The stages include:

Stage 1: An arthroscopic (minimal invasive surgery) shoulder surgery will be performed to repair the tendon. This procedure allows only partial repair due to poor tissue quality and/or the large size of the tear. After the surgery, a pillow sling will be used for 6 weeks to hold your arm and to release tension off the rotator cuff. To get ready for stage 2, you will be prescribed a special physiotherapy course after the healing period.

Stage 2: A second arthroscopic surgery will be performed to repair the remaining tear by using a patch of the Graft jacket. After 4-6 weeks of the surgery, your doctor will recommend a physiotherapy course for improving your shoulder functions.

Benefits of Graft jacket

The benefits of Graft jacket include:

  • Exceptional strength
  • Favourable handling properties
  • Compatible with human tissue
  • Helps in revascularization (restores blood supply)
  • Increases the population of cells in the matrix