Biologic augmentation in rotator cuff repair: current evidence and future directions

Despite surgical advancements, high failure rates of rotator cuff repairs (RCRs) remain a significant concern, with success rates varying from 16% to 94%. This paper reviews current evidence on biologic augmentation strategies, including platelet-rich plasma, mesenchymal stem cells, and biologic scaffolds, that improve healing and reduce retear rates. Current research on biologic augmentation presents mixed results. While preclinical and clinical studies show improved structural healing and functional scores, a lack of standardized protocols for application, concentration, and surgical technique leads to heterogeneity in outcomes. The review also touches on other emerging modalities like gene therapy and amniotic membrane-derived products. Biologic augmentation holds great promise for optimizing rotator cuff repairs; however, to achieve clinical effectiveness and widespread adoption, future research must focus on large-scale human trials to establish standardized protocols that would most benefit patients.