Rotator cuff repair and biologic augmentation-what do we know?

Background: Despite advancements in rotator cuff repair (RCR) techniques, failure of tendon healing remains common. In recent years, there has been an increasing body of work assessing the healing environment of the injured rotator cuff and exploring which adjuncts may be suitable to augment repairs. Methods: In this review, we summarize the best available literature regarding the biology of rotator cuff healing and the use of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), scaffold-, and graft-based augmentations to RCR to guide the treating clinician. Results: Proposed treatment modalities range from injection-based augmentation such as PRP and BMAC to scaffold and graft-based augmentations at the time of RCR. Conclusion: The field of biologic augmentation for RCR is rapidly evolving and has demonstrated substantial potential in improving structural integrity and healing rates. PRP, BMAC, as well as scaffold- or graft-based strategies, have all shown promise; however, variability in study methodology, preparation techniques, and clinical outcomes continue to limit definitive recommendations. Key challenges remain, including the need for optimization and standardization of biologic formulations, patient selection criteria, and cost-effective analyses. The need for well-powered, high-quality randomized controlled trials with standardized protocols are paramount to guiding clinical decision-making. The need to optimize RCR is clear, and the interest is evident in the numerous studies in the field. Future studies should aim to establish clear guidelines for biologic augmentation, ensuring that evidence-based applications can optimize patient outcomes in the future.