Abstract Despite multiple advancements in rotator cuff repair fixation and technique that have allowed for stronger and more anatomic constructs, failure remains commonplace. As is a common theme throughout orthopaedics, both biomechanics and biology play a role in successful healing. The new frontier in tendon‐to‐bone healing appears to be pairing biologic augmentation, such as bone marrow aspirate concentrate (BMAC), with previous biomechanical advancements. However, only 8 studies have specifically investigated the utility of BMAC in rotator cuff repair, and as of yet, there are minimal data to suggest that recent biologic technologies have shown clinical effectiveness. The technology has been more comprehensively studied in knee arthritis with similarly disappointing clinical results. Rotator cuff repair outcomes are dependent on many factors inherent to the injury (e.g., chronicity, bone quality, tendon quality, retraction), the patient (e.g., age, smoking, diabetes, adherence to postoperative protocol), and the surgeon (e.g., quality of technique, repair tension, patient education). Trying to decide the efficacy of BMAC or other cell‐based technology is going to be very difficult.