Rationale of Tendon-to-Bone Healing

Rotator cuff tears affect 30–50% of people older than 50 years. With recent population aging and increase in functional demands of elderly people, there is growing interest in rotator cuff disorders. Despite the constant improvements in surgical techniques and technologies, rotator cuff re-tear after surgical repair remains a significant problem involving up to 20–40% of small-to-medium tears and till 90% or more of large or massive tears. This high re-tear rate has arisen the interest in the tendon-to-bone healing processes and on the possible interventions to strengthen this process. So far, two are the ways that have been most explored to implement the usual surgical techniques: “biochemical augmentation” (adding stem cells and macromolecules with a predominant biochemical effect) and “biomechanical augmentation” (adding grafts that exercise a primarily mechanical effect, while still presenting some degree of biological healing). In this chapter, we present the most used augmentation techniques to enhance tendon-to-bone-healing in rotator cuff repair.