Biological solutions in rotator cuff healing

One of the most common causes of shoulder pain and dysfunction is rotator cuff tears, and the extent of this problem is increasing with an aging population. High retear rates after rotator cuff repairs suggest that simple repairs lack the mechanical integrity to promote effective tendon healing. Greater insight into the biology underlying tendon healing processes have suggested a number of target pathways that could be modulated to encourage tendon healing after rotator cuff repairs. This review evaluates the evidence to support commonly used biological therapies and also novel and future therapeutics. The scope of this review encompasses biological therapies, modulation of systemic factors that contribute to tendinopathies and healing, as well as cellular and structural repair solutions. The role for mechanical modulation of tendon biology is also considered.