Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair


– The paper reviews biological strategies used to augment rotator cuff repair and enhance tendon healing.
– Slow healing, high retear rates, and impaired biomechanical properties are challenges with rotator cuff repair surgery. Bioaugmentation aims to address these issues.


– Literature on use of biologics including platelet-rich plasma (PRP), growth factors, stem cells, and exosomes for rotator cuff repair was reviewed.
– Animal models and human applications were summarized.

Biologics Reviewed

– PRP contains growth factors that stimulate healing, but clinical outcomes are inconsistent.
– Growth factors like VEGF, IGF-1, TGF-β, and PDGF-BB influence cell proliferation, angiogenesis, and matrix synthesis based on animal studies.
– Stem cells from bone marrow, adipose tissue, and tendon tissue have potential to differentiate into tendon cells and modulate inflammation.
– Exosomes derived from mesenchymal stem cells may stimulate healing via transfer of miRNA and proteins.


– Clinical translation of biologics has shown promise but variable outcomes. Standardization of PRP preparation and delivery is needed.
– Growth factors show positive results in animal models but clinical effects in humans remain unclear.
– Stem cells and exosomes require more investigation to demonstrate clinical feasibility and safety.
– Combining biologics that target different phases of healing may have synergistic effects.


– Preclinical evidence supports potential for biologics like growth factors, stem cells and exosomes to improve rotator cuff healing.
– However, clinical benefits in human trials remain inconclusive. Further research on mechanisms and randomized controlled trials in humans are needed to optimize utilization of biologics during rotator cuff repair.

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© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow