Recent concepts in biological augmentation for rotator cuff tears: a scoping review

Surgical repair of rotator cuff tears is common, but failure rates remain a significant clinical challenge, particularly in large or degenerative tears. Augmentation strategies have been developed to enhance the biological and mechanical environment of the repair, aiming to improve healing and reduce retear rates. To provide a comprehensive scoping review of current biological augmentation strategies for rotator cuff repair, summarizing the underlying rationale, available materials, and recent clinical evidence to guide surgical decision-making. A systematic literature search was conducted and keywords related to rotator cuff repair and augmentation were used. Included studies investigated biological or combined biological and synthetic augmentation in human or animal subjects. The search yielded 419 studies for qualitative synthesis. Augmentation techniques were categorized into allografts, xenografts, autografts, platelet-rich plasma (PRP), stem cells, non-tissue grafts, and other biological adjuncts. Human dermal allografts were the most frequently studied augmentation strategy and were associated with favorable healing and clinical outcomes in several studies. Autografts, such as fascia lata and the long head of the biceps tendon, have emerged as promising alternatives with favorable biocompatibility. Evidence for PRP and stem cells remains inconsistent, with no universal consensus on preparation and application techniques. Non-tissue synthetic grafts offer mechanical support but lack long-term data. Augmentation provides a valuable tool for improving healing in high-risk rotator cuff repairs. Human dermal allografts and autografts are supported by the strongest and largest amount of current evidence. However, no single strategy is universally superior. Future research should focus on large-scale, standardized comparative trials and combinatory approaches that merge structural support with targeted biologic enhancement.