Biologic Adjuvants for Rotator Cuff Augmentation

Rotator cuff tears are a common injury in adults, and many patients will subsequently require surgical repair. While advancements in surgical technique have allowed for excellent time-zero mechanical repair of rotator cuff tears, retears remain a significant issue for patients and surgeons. Biologic adjuvants have been under investigation with the hope of reducing retears by enhancing the healing milieu following mechanical repair. Some of these adjuvants, which include platelet-rich plasma (PRP) products and pluripotent cell populations derived from bone marrow and subacromial bursa tissue can be harvested from the patient and administered intraoperatively. Our aim is to highlight the features of these adjuvants and review how they are implemented, including clinical outcomes when possible. Despite a significant amount of randomized controlled trials, inconsistent characterization of PRP products and lack of standardization regarding the production and implementation of PRP have led to heterogenous studies. Bone marrow aspirate concentrate and subacromial bursa tissue have shown the potential to enhance cellular regeneration but currently lack substantial clinical evidence. While standardization of methods may be impractical due to the numerous options for implementation, more consistent characterization of biologics may expedite progress toward consensus. Newer adjuvants in the setting of rotator cuff repair include exogenous pluripotent cells from human amnion, as well as bio-inductive scaffolds, and conditioned medium. As research on these burgeoning adjuvants grows, efforts to increase transparency through improved reporting and detailed methods may help to push this field forwards.