Title Image

Retrospective Review of the use of the Rota-Lok system for massive rotator cuff repairs

Completed Research

Retrospective Review of the use of the Rota-Lok system for massive rotator cuff repairs


Massive rotator cuff tears can be painful and debilitating to the patient and very difficult to manage from a surgeons’ point of view.

Massive cuff tears are defined as a rotator cuff tear involving complete disruption of two or more tendons of the rotator cuff or a tear greater than 5cm. Due to their chronic nature they are often associated with significant fatty infiltration of the muscle belly and retraction of the tear, often rendering them irreparable. Accepted treatment methods for these types of tears include tendon transfers, joint debridement & denervation and in the older population arthroplasty. Most recently augmentation of the rotator cuff has been explored due to the advent of synthetic woven devices that may incorporate body tissue.


New techniques to augment rotator cuff repairs with synthetic ligaments have little in the way of long-term data behind them. However equipoise exists due to the fact that here is often little else that can be offered to the patient and the other treatments also have at best, fair results. This study aimed to demonstrate that the use of the Rota-Lok System to augment and enable rotator cuff repair is a safe and reliable alternative to the already established techniques.


To examine the clinical and radiological outcomes of patients undergoing a new surgical technique and determine its safety and efficacy.


This was a retrospective cohort study. There were a number of patients who had already been consented for implantation of this device and had this new surgical technique performed. They were followed up within this study by way of physical examination, subjective and objective questionnaires and an MRI scan at 6 months post-surgery.

Study Procedure

Consenting patients with a massive rotator cuff tear underwent an open rotator cuff repair using a mini-open technique with augmentation of the repair using the artificial ligament system known as the Rota-Lok. This is an artificial ‘Neo-Tendon’, which is inserted through and behind the rotator cuff tear in order to aid its reduction to the humeral head. This study examined the clinical and radiological outcomes of these patients retrospectively. It examined functional and pain outcomes, as well as cuff healing through MRI assessment.

Inclusion Criteria

  • Clinical and radiological diagnosis of massive rotator cuff tear
  • Patients who have had rotator cuff repair surgery using the Rota-Lok System
  • Patients who are capable of and have given informed consent to their participation in the study

Exclusion Criteria

  • History of previous shoulder infection

Ethics and Governance

Approved by North Shore Private Hospital Human Research Ethics Committee to be undertaken at North Shore Private Hospital.
HREC reference NSPHEC 2015-002.


Baseline Characteristics

19 patients were reviewed and completed follow up examination and MRI. Patient average age was 61.6±7.2 years range 45-76. Fifteen patients were male and the right side was affected in 10 patients. Average length of time from surgery was 13.4±4.9 months.

Functional Outcomes

Patients had an average forward elevation of 167±29 degrees and an average abduction strength of 4.1±2.6 kg. No differences were noted between patients whose rotator cuff healed and those who had recurrent tears on MRI were noted with regard to patient-rated outcomes, forward elevation or abduction strength p>0.05.

Repair Integrity

Post-operative MRI demonstrated an intact rotator cuff in 14 patients (a Sugaya Score of 1-3). Eight of these patients had a thin but intact rotator cuff (Sugaya Score of 3). And five patients had recurrent tears on post-operative MRI (a Sugaya Score of 4-5). This represents a healing rate of 74%.

The results of this study suggest The Rota-Lok system to be a safe and reliable method to augment rotator cuff repair in massive rotator cuff tears.


  • Bond JL, Dopirak RM, Higgins J, Burns J, Snyder SJ. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy: the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2008 Apr;24(4):403–409.e1. doi:10.1016/j.arthro.2007.07.033
  • Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000 Apr;82(4):505–515.
  • Gerber C, Wirth SH, Farshad M. Treatment options for massive rotator cuff tears. J Shoulder Elbow Surg. 2011 Mar;20(2 Suppl):S20–9. doi:10.1016/j.jse.2010.11.028
  • Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994 Jul;(304):78–83.
  • Itoi E, Minagawa H, Sato T, Sato K, Tabata S. Isokinetic strength after tears of the supraspinatus tendon. The Journal of bone and joint surgery. British volume. 1997 Jan;79(1):77–82.
  • Meyer DC, Lajtai G, Rechenberg von B, Pfirrmann CWA, Gerber C. Tendon retracts more than muscle in experimental chronic tears of the rotator cuff. The Journal of bone and joint surgery. British volume. 2006 Nov;88(11):1533–1538. doi:10.1302/0301-620X.88B11.17791
  • Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. The Journal of bone and joint surgery. British volume. 1995 Mar;77(2):296–298.
  • Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10–15.
  • Wong I, Burns J, Snyder S. Arthroscopic GraftJacket repair of rotator cuff tears. J Shoulder Elbow Surg. 2010 Mar;19(2 Suppl):104–109. doi:10.1016/j.jse.2009.12.017
  • Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. Journal of Shoulder and Elbow Surgery. 2001 May;10(3):199–203. doi:10.1067/mse.2001.113086
  • Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CWA, Gerber C. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am. 2007 Sep;89(9):1928–1934. doi:10.2106/JBJS.F.01073
  • Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. The Journal of Bone and Joint Surgery. 2008 Nov;90(11):2423–2431. doi:10.2106/JBJS.G.00677
  • Zvijac JE, Levy HJ, Lemak LJ. Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 1994 Oct;10(5):518–523.
  • Fujikawa K, Iseki F, Seedhom BB. Athroscopy after anterior cruciate reconstruction with the Leeds-Keio ligament. British Editorial Society of Bone and Joint Surgery. 1989;71-B:566-70.
  • Zaffagnini S, Muccioli GMM, Chatrath V, Bondi A, De Pasquale V, Martini D, Bacchelli B, Marcacci M. Histological and ultrastructural evaluation of Leeds-Keio ligament 20 years after implant: a case report. Knee Surgery, Sports Traumatology, Arthroscopy. 2008;16:1026-1029.
  • Bigliani L U, Morrison D S, April E W. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 1986;10:228.
  • Nyffeler R W, Werner C M, Sukthankar A, Schmid M R, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg (Am) 2006; 88 (4): 800-5.
  • Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle. Bone Joint J.2013 Jul;95-B(7):935-41.
  • Tétreault P, Krueger A, Zurakowski D, Gerber C. Glenoid version and rotator cuff tears. J Orthop Res. 2004 Jan;22(1):202-7.

Lead Investigator:

Dr Benjamin Cass


June 2015


June 2016


In the submission stage


Shoulder and Elbow Society of Australia bi-ennial closed conference Darwin 2016


Completed Research

{Updated November 2016}

The VAULT Study (Reliability of Glenoid Version Measurement on 3D-corrected axial CT scan)
In Research - Completed

Humeral Head to Greater Tuberosity Angle Study

In Research - Completed

Retrospective Review of the use of the Rota-Lok system for massive rotator cuff repairs

In Research - Completed

Early mobilisation following rotator cuff repair

Propionibacterium acnes
In Research - Completed

Propionibacterium acnes contamination in shoulder surgery

In Research - Completed

Modified Biceps Repair

In Research - Completed

Improving medial footprint coverage in double row cuff repair using FiberTape

In Research - Completed

Rate of P Acnes in arthritic shoulders undergoing primary total shoulder replacement surgery using a strict specimen collection technique

In Research - Completed

Comparative study of physician applied and patient reported Constant Scores utilising bathroom scales to derive force measurements

The VAULT Study - Glenoid Version Measurement
In Research - Completed

The VAULT Study – Glenoid Version Measurement

The FUSE Study (Fitness band Used in Shoulder Evaluation)
In Research - Completed

The FUSE Study – Fitness band Used in Shoulder Evaluation

In Research - Completed

Precision and Accuracy of Pumps used in Shoulder Arthroplasty

TXA Study (Systemic Tranexamic Acid in Shoulder Arthroplasty
In Research - Completed

The TXA Study (Systemic Tranexamic Acid in Shoulder Arthroplasty)

In Research - Completed

The TXA 2 Study (Systemic Tranexamic Acid in Shoulder Arthroscopy and Rotator Cuff Repair)