Biologic and Synthetic Augmentation in Rotator Cuff Repair: Emerging Technologies

➢ Biologic and synthetic augmentation grafts have been developed to enhance both the mechanical integrity of rotator cuff repairs and the biologic healing at the tendon-bone interface, particularly in the setting of compromised tissue quality.➢ Xenograft augmentation is no longer favored because of inconsistent clinical outcomes, inflammatory responses, and a lack of supportive high-quality evidence.➢ Allograft and synthetic graft augmentation may provide benefit in selected cases; however, optimal indications, implant selection, and long-term outcomes remain incompletely defined.➢ Bioinductive collagen implants currently demonstrate the highest level of clinical evidence, with Level-I studies supporting improved structural healing and reduced retear rates in appropriately selected patients.➢ The long head of the biceps tendon autograft represents a viable, cost-effective biologic augmentation option when available, providing favorable biologic compatibility and surgical versatility.