Recent Updates on Allograft Selection for Reconstruction of Massive Rotator Cuff Tears

Massive rotator cuff (RC) tears often require advanced reconstructive procedures, with graft selection playing a critical role in determining surgical success. Autografts offer excellent biocompatibility but are limited by donor site morbidity and inconsistent mechanical strength. Acellular dermal matrix grafts support host integration but are prone to elongation and variable resorption. Tendon allografts provide superior tensile strength but may integrate slowly depending on processing methods. Synthetic and xenografts offer alternative options, yet long-term durability and immune response remain concerns. Recent improvements in graft processing, including decellularization and ready-to-use technologies, have enhanced clinical efficiency but introduced new questions about long-term performance. Given the lack of standardized guidelines, graft selection should be tailored to patient-specific factors such as age, activity level, and tissue quality. This review evaluates current graft options for reconstruction of massive RC tears, providing evidence-based insights to support personalized surgical decision-making.