Rotator cuff repair augmentation: a review of current techniques

Abstract

Rotator cuff tears are one of the most common orthopedic injuries, affecting nearly 40% of individuals over 60 years old. Surgical repair remains the gold standard following failed conservative treatment; however, retear rates remain a significant challenge, with some studies reporting recurrence in 40% to 94% of patients. In response to these high failure rates, various surgical augmentation techniques have been developed, offering the potential to enhance healing, improve repair integrity, and optimize long-term outcomes. A comprehensive literature review was conducted to assess the current methods of augmentation for rotator cuff repair (RCR) and to provide an updated analysis of augmentation techniques for RCR from 2010 to 2025. The review includes detailed descriptions of each augmentation technique, along with associated outcomes and available evidence supporting their use in clinical practice. Augmentation techniques for RCR have advanced, showing promising improvements in patient outcomes. This review highlights the growing popularity of dermal allografts and bioinductive collagen implants, alongside the emerging use of platelet-rich plasma (PRP), bone marrow aspirate concentration (BMAC) and fibrin clots. While these methods demonstrate potential, further high-quality randomized, prospective studies are needed to standardize protocols, establish clear indications, and address the variability in current evidence. Key areas requiring further investigation include the long-term durability of augmented repairs, optimal patient selection criteria, the comparative efficacy of different augmentation materials, and the cost-effectiveness of these techniques in routine clinical practice.

Keywords: Rotator cuff tear; augmentation techniques; outcome; rotator cuff repair (RCR).