The limited regenerative capacity of the tendon-bone enthesis after surgical repair poses a significant challenge to achieving desired clinical outcomes. Biologic augmentation of the repair site has the potential to enhance the biomechanical and histological integrity of the enthesis, leading to lower retear rates and greater patient satisfaction. Platelet-rich plasma, stem cells and bone marrow aspirate concentrate, growth factors, biodegradable or biomimetic scaffolds, and amniotic products have been investigated in preclinical and, in some cases, clinical studies aimed at augmenting tendon-bone healing. Although many of these therapies have achieved some degree of success in improving structural, histological, and clinical outcomes after surgical tendon-bone enthesis repair, none have reliably and consistently lead to clinical improvement. High-quality randomized controlled clinical studies are needed to definitively evaluate the efficacy of these biologic therapies and ultimately determine which, if any, are capable of achieving a tendon-bone repair that is structurally noninferior to the native enthesis before injury.T he high rate of reinjury after the surgical repair of rotator cuff tears represents a significant clinical challenge. An estimated 250,000 rotator cuff repairs are performed each year in the United States, 1 and retear rates after surgery have been reported to range from 24 to 94% depending on age, chronicity, tear size, and repair technique, among other factors. 2 Surgical techniques and supplemental therapies that lead to a more robust tendon-tobone reattachment after repair are needed to diminish the psychological and economic burden that results from retears, revision procedures, additional rehabilitation, and missed work.The native tendon-to-bone enthesis morphology is not regenerated after injury and surgical repair. Rather, a structurally and histologically inferior enthesis microarchitecture results (Figure 1). The need to identify biologic agents that have the capacity to regenerate the native tendon-bone enthesis after surgical repair is apparent. Recent preclinical and clinical research has aimed to identify and evaluate the efficacy of these orthobiologics. Therefore, the purpose of this review was to critically analyze preclinical and clinical studies on the use of orthobiologics for tendon-to-bone healing published in
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