Rotator cuff tears are a common orthopedic diagnosis in daily practice. The failure rate is still high despite the continued developments in suture material and techniques in both the open and arthroscopic approaches. In recent years, the physiological processes in the bone tendon insertion as well as the biological characteristics of rotator cuff healing have received increasing attention by researchers. It has been shown that the healing of the tendon bone insertion is a complex interplay of local cells, progenitor stem cells, extracellular matrix, growth factors, and other cytokines. Accordingly, several biological in vitro and in vivo therapy methods were developed to improve reinsertion. This article provides an overview of the current evidence for augmentation of rotator cuff reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed.