Rotator cuff disease, repair and augmentation

Rotator cuff disease (RCD) is the leading cause of shoulder disability, characterized by progressive degeneration of tendon structure and function. Despite advances in surgical techniques that optimize repair biomechanics, biological healing remains a major challenge, leading to high rates of repair failure. Augmentation strategies, including biologic adjuvants, grafts, and bioinductive implants, aim to improve the healing environment and reduce re-tear rates. Although augmentation reliably reduces structural failure, its clinical benefits remain under investigation. Continued advancements in biologic therapies, graft technologies, and long-term clinical studies are needed to optimize outcomes and define best practices for augmentation in rotator cuff repair. This review summarizes the current understanding of RCD pathophysiology, natural history, treatment strategies, surgical repair techniques, healing mechanisms, and the role of augmentation.