Rotator cuff tears are a prevalent condition, particularly in older populations, with significant implications for shoulder stability and function. They are generally considered a part of the normal aging process. They are present in approximately 15–20% of 60 year olds, 26–30% of 70 year olds, and 36–50% of 80 year olds. Most individuals with rotator cuff tendon tears remain asymptomatic, for others, these tears become a source of substantial pain and functional impairment. These tears often arise from a combination of intrinsic and extrinsic factors. Orthobiologics have emerged as promising adjuncts to enhance tendon healing. Platelet-rich plasma (PRP) modulate inflammation, promote cell migration, and enhance extracellular matrix (ECM) synthesis. However, inconsistencies in preparation methods and clinical outcomes have limited its widespread adoption. Patch augmentation, either synthetic or biological, involves applying a graft during surgical repair to be applied on top of the repaired cuff tendon (onlay), underneath the tendon (interposition), or in a “bridging” fashion to fill the defect between the tendon edge and the bony footprint. Human dermal allografts are the most commonly used biological grafts due to their availability and favourable biomechanical properties. However, differences in decellularisation methods, preparation, and hydration among products limit comparative studies and standardisation. Ideal orthobiologics in rotator cuff regeneration should aim to enhance healing by leveraging optimised growth factors in injectable formulations and the ideal biocompatible patches should be able to seamlessly integrate with native tissues while providing sustained biomechanical support. Furthermore, achieving standardisation in preparation methods and clinical applications remains crucial for ensuring safety, efficacy, and widespread adoption.