Review ArticleBiologic and Synthetic Grafts in the Reconstruction of Large to Massive Rotator Cuff TearsGillespie, Robert J. MD; Knapik, Derrick M. MD; Akkus, Ozan PhDAuthor Information From the Department of Orthopaedic Surgery, University Hospitals, Cleveland Medical Center (Dr. Gillespie, Dr. Knapik, and Dr. Akkus), and the Department of Mechanical and Aerospace Engineering, Case Western Reserve University (Dr. Akkus), Cleveland, Ohio. Dr. Gillespie or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of Wright Medical Technology and DJO Global. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Knapik and Dr. Akkus. Journal of the American Academy of Orthopaedic Surgeons: December 2016 - Volume 24 - Issue 12 - p 823-828 doi: 10.5435/JAAOS-D-15-00229 Metrics Abstract Rotator cuff injuries are common in both young and elderly patients. Despite improvements in instrumentation and surgical techniques, the failure rates following tendon reconstruction remain unacceptably high. To improve outcomes, graft patches have been developed to provide mechanical strength and to furnish a scaffold for biologic growth across the delicate tendon-bone junction. Although no patch effectively re-creates the structured, highly organized system of prenatal tendon development, augmenting rotator cuff repair may help restore native tendon-to-bone attachment while reproducing the mechanical and biologic properties of native tendon. An understanding of biologically and synthetically derived grafts, along with knowledge of the preliminary data available regarding their combined use with growth factors and stem cells, is needed to improve management and treatment outcomes. The current literature has not been consistent in showing patch augmentation to be beneficial over traditional repair, but novel scaffolding materials may help facilitate rotator cuff tendon repair that is histologically and biomechanically comparable to native tendon. Copyright 2016 by the American Academy of Orthopaedic Surgeons.