Sutures and suture anchors are commonly used in rotator cuff repairs as they offer cost-effective and mechanically robust solutions for tendon-bone interface (TBI) healing. However, in large to massive rotator cuff tears, where substantial tendon loss and limited intrinsic healing potential are present, conventional repair techniques alone often fail to restore the native biomechanics and structural integrity. Consequently, retear rates in these cases remain unacceptably high. This review summarizes recent advances in graft-based augmentation strategies aimed at improving outcomes in these challenging clinical scenarios. Furthermore, we propose a novel biomaterial that can be easily shaped, promotes endogenous cell activity throughout tendon regeneration, and offers sufficient mechanical support to the TBI.