Update on Biologics in the Treatment of Rotator Cuff Disease

Abstract

Rotator cuff disease is the most common condition affecting the shoulder, causing significant pain and functional impairment in the adult population. Improvements in arthroscopic instrumentation and suture anchor technology have allowed the development of stronger constructs with multiple suture configurations, allowing repair of large and massive tears through minimally invasive means. However, although repair instrumentation and techniques have improved, healing rates have not. A high failure rate remains for large and massive rotator cuff tears. The next frontier in the management of rotator cuff disease is biologic augmentation to facilitate healing following repair. The biology of the patient and the tendon remains a notable factor in rotator cuff healing. Repair efforts are negatively affected by decreased vascularity with normal aging, increased collagen fragility, muscle atrophy, and fatty infiltration of the chronically torn tendon. Surgical techniques to enhance the biology of the repair site and improve mechanical stability should be used whenever possible. Recognizing the tear pattern and performing an anatomic, tension-free repair provides the best chance for success. Microfracture of the healing bed of the greater tuberosity 1