Timothy Cobb - Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-On-Sea, UK
Richard Dimock - The Rowley Bristow Unit, Ashford and St. Peter’s NHS Trust, Chertsey, UK
Sahib Memon - The Rowley Bristow Unit, Ashford and St. Peter’s NHS Trust, Chertsey, UK
Paolo Consigliere - ۳ University Hospitals Bristol and Weston NHS FT, Bristol, UK ۴ Reading Shoulder Unit, Reading, UK
Sam Ajami - University of Manchester, UK
Mohamed Imam - The Rowley Bristow Unit, Ashford and St. Peter’s NHS Trust, Chertsey, UK- Smart Health Unit, University of East London, London, UK
A. Ali Narvani - The Rowley Bristow Unit, Ashford and St. Peter’s NHS Trust, Chertsey, UK- Fortius Clinic, London, UK

Background: Repair of massive rotator cuff tears remains a challenging process with mixed success. There is agrowing interest in the use of patches to augment the repair construct and the potential to enhance the strength,healing, and associated clinical outcomes. Such patches may be synthetic, xenograft, or autograft/allograft, and avariety of techniques have been tried to biologically enhance their integration and performance. The materials used arerapidly advancing, as is our understanding of their effects on rotator cuff tissue. This article aims to evaluate what wecurrently know about patch augmentation through a comprehensive review of the available literature.Methods: We explore the results of existing clinical trials for each graft type, new manufacturing methods, noveltechniques for biological enhancement, and the histological and biomechanical impact of patch augmentation.Results: There are promising results in short-term studies, which suggest that patch augmentation has greatpotential to improve the success rate. In particular, this appears to be true for human dermal allograft, while porcinedermal grafts and some synthetic grafts have also had promising results.Conclusion: However, there remains a need for high-quality, prospective clinical trials directly comparing each type ofgraft and the effect that they have on the clinical and radiological outcomes of rotator cuff repair.Level of evidence: IV

biological enhancement, Extracellular matrix, patch augmentation, Rotator Cuff, Rotator cuff repair, Rotator cuff tear, tissue scaffolds