Synthetic augmentation in massive rotator cuff tears

Massive rotator cuff tears represent a great challenge in orthopaedic. They are associated with persistent defects, weakness, and poor outcomes and can cause an uncoupling of forces across the glenohumeral joint, with unstable shoulder kinematics. In the last few years, a notable interest has emerged to develop new treatment strategies that provide effective mechanical reinforcement of rotator cuff repair and stimulate and enhance the patient's intrinsic healing potential. Tissue engineering techniques using novel scaffold materials offer potential alternatives for managing massive irreparable rotator cuff tears. Synthetic scaffolds, manufactured from chemical compounds, have gained much interest to bridge massive rotator cuff tears. Preliminary studies support the idea that synthetic scaffolds can provide an alternative for rotator cuff augmentation with an enormous therapeutic potential. Despite the growing clinical use of synthetic scaffold devices for rotator cuff repair, there are numerous questions related to their indication, surgical application, safety, mechanism of action, and efficacy that remain to be clarified or addressed. We review the current basic science and clinical understanding of synthetic scaffolds for massive rotator cuff repair, reporting the preclinical and clinical studies carried out to date in this field. We underline the benefits and limitations of the available synthetic scaffolds for augmentation of rotator cuff tears, and discuss the implications of these literature data on the future directions for the use of these scaffolds in tendon repair procedures.