Biological Augmentation in Repair and Reconstruction of the Rotator Cuff

Rotator cuff tears are among the most common causes of pain and disability in the upper extremity. Despite significant advances in repair techniques and instrumentation, retear rates after surgery remain high. Numerous avenues of structural and biological augmentation have been explored to increase healing potential and achieve successful outcomes particularly in patients with massive cuff tears and those undergoing revision surgery. The purpose of this article is to present and discuss various techniques currently published that are designed to augment this process through variable methodologies. A common methodology is the use of graft tissue to “load share” with the repair or facilitate placement of pluripotential stem cell or growth factors at the site of needed healing or both. Although this field remains in development, this article attempts to explain the concepts currently employed and summarize the current Food and Drug Administration–approved options.