Autologous Tendon “Bamboo Raft” Graft for Reconstruction of Massive Irreparable Rotator Cuff Tears

Figures

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  Fig 1. Bamboo raft graft placement. Initially, the semitendinosus and gracilis hamstring tendons are harvested and meticulously shaped. Subsequently, continuous suture techniques are used to reinforce the graft, particularly in the central region, thereby creating a structure analogous to a bamboo raft. This graft is then used for superior capsular reconstruction in cases of massive irreparable rotator cuff tears. (A, acromion; Cl, clavicle; Co, coracoid process; H, humerus; K, Reelx knotless anchor; L, superior glenoid labrum; LHBT, long head of biceps tendon; n, double-suture bone anchors; N, inner-row double-suture bone anchors; SB subscapularis.)

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  Fig 2. (A) The patient is comfortably seated on the examination table, with the backrest positioned at an angle of approximately 70° to 80° (Beach displacement, right shoulder). The shoulder and the opposite lower limb are prepared and draped in a sterile manner. The arm is placed in slight forward flexion and abduction, facilitating access to the subacromial space. Arrow indicates a 2-3 cm oblique incision. (B) Relevant surface anatomy markings include the acromion, clavicle, and coracoid. The posterior portal, which is the primary viewing portal, is made approximately 2 cm inferior and 2 cm medial to the posterolateral border of the acromion. The anterior portal is made 1 cm lateral to the coracoid. The lateral working portal is made 1 cm distal to the lateral edge of the acromion. A, anterior portal; B, lateral portal; C, posterior portal.

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  Fig 3. Arthroscopic view of right shoulder through posterior portal. (A) By use of a 2-mm shaver in the anterior portal, a subacromial bursectomy is performed to expose the lower surface of the acromion and the anterior and lateral edges. This procedure allows for exploration of the rotator cuff injury and the shape of the acromion. The bursectomy is organized from anterior to posterior and lateral to medial. (B) By use of a 3-mm NanoResection burr (Arthrex) in the anterior portal, acromioplasty is performed by gradually resecting the anterior and lateral bone spurs. Care is taken laterally to avoid damaging the deltoid muscle fibers. Depending on the surgeon’s preference, an additional lateral portal can be created for further bony resection. Through this lateral portal, the acromioplasty can be continued while viewing from the posterior portal. Subsequently, the burr can be placed in the posterior portal while viewing from the lateral portal to ensure the complete resection of any osteophytes. The long arrow indicates the acromion and the short arrow indicates the humeral head. (LHBT, long head of biceps tendon.)

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  Fig 4. (A) Bamboo raft. (B) Bamboo raft graft. (C) A 2- to 3-cm oblique incision is made on the medial side of the tibial tubercle of the opposite knee joint (the left knee). After the fascial layer is incised, the footprint area of the anserine bursa is exposed. The semitendinosus and gracilis muscles are then carefully separated to facilitate extraction of the entire tendon. (D) Continuous edge-to-edge sutures are used to create a sealed graft after folding the tendon to match the length of the supraspinatus defect. High-strength No. 2 FiberWire sutures are crisscrossed 3 times in the center to enhance graft stability and prevent loosening during transplantation. This results in an autologous tendon graft resembling a bamboo raft. PDS II sutures are used for traction by passing through the 4 corners of the graft. (E) The graft measures 5 cm in length, 4.5 cm in width, and 4.1 mm in thickness. GT, gracilis tendon; HT, Hamstring tendon; ST, Semitendinosus tendon.

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  Fig 5. (A) The graft is positioned at the superior joint capsule by pulling the reserved PDS II sutures attached to the graft. Subsequently, the anchor sutures are passed around the graft and secured with knots under direct visualization. (B) Arthroscopic view of right shoulder through posterior portal. The graft is fixed on the glenoid and tubercle sides of the humerus, maintaining moderate tension. An outer-row anchor (4.9 mm × 20 mm, Versalok Suture Anchor) is driven into the humeral tubercle side to secure the graft in the footprint area further. Arthroscopic examination confirms complete graft coverage, no rotation or folding, and no active bleeding ( the arrow indicates the"bamboo raft" graft).

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  Fig 6. (A) Preoperative T2-weighted magnetic resonance imaging (MRI) in coronal plane showing massive rotator cuff tear retracted at glenoid level (arrow). (B) Postoperative T2-weighted MRI in coronal plane at 3 months showing bamboo raft graft (arrow). (C) Postoperative T2-weighted MRI in coronal plane at 12 months showing bamboo raft graft (arrow).