<p>Due to the relevant retear rates following rotator cuff (RC) repair, adjuvant biological augmentation techniques to improve the healing potential have recently gained increasing attention and are frequently used for chronic RC tears. These include the use of platelet-rich plasma (PRP), mesenchymal stem cells (MSC) from concentrated bone marrow aspirates (BMAC) or the subacromial bursa (SAB). Recently, augmentation techniques using sartans or bisphosphonates were suggested to improve outcomes after RC repair. The use of PRP remains controversial due to different manufacturing methods coupled with the inconsistent quality of PRP end products and associated with variable clinical outcomes. The currently available limited evidence for augmentation with BMAC suggests that the related improvement of tendon healing can also positively impact clinical results; however, it is an expensive procedure with questionable cost-effectiveness and is subject to strict regulatory requirements. No improvement in postoperative outcomes following augmentation with MSCs from the SAB has so far been observed, with clinical evidence limited only to small case series without prospectively randomized data. While animal studies reported encouraging data, no clinical benefit was observed regarding structural improvement using sartans. Promising results using bisphosphonates in patients with osteoporosis following RC reconstruction were recently reported, although the effect in patients without osteoporosis is still under investigation. In summary, no clear recommendation can be made for any of the abovementioned biological adjuvants used for augmentation.</p>