Orthobiologic Augmentation to Improve Rotator Cuff Repair Outcomes: Current and Future Strategies

Rotator cuff tear (RCT) management continues to represent a notable area of research given its widespread prevalence. Although current strategies of care focus on pain reduction and functional restoration, there has been an increasing amount of focus on the orthobiologics of RCTs in hopes of delivering more efficient, targeted therapies. Understanding these cellular mechanisms of rotator cuff injury outcomes is thus crucial in advancing biologic treatments; as such, this article first aims to summarize the orthobiologic mechanisms that underpin post-RCT tendon-bone healing and muscle degeneration. Next, we review the current strategies of biologic augmentation, including bone marrow stimulation, platelet-rich plasma, and mesenchymal stromal and stem cell therapy. Finally, we offer insights into the future of cell-based treatments, from harnessing extracellular vesicles to deliver biologic therapies to inducing promyogenic cellular differentiation at the site of injury.