Can we use MRI for timing estimation of rotator cuff tears?

PURPOSE: To evaluate whether routinely assessed MRI features can reliably estimate the timing of rotator cuff tears (RCTs) and to assess the performance of an MRI-based logistic regression model in distinguishing recent from chronic tears.

MATERIAL AND

METHODS

In this retrospective single-center study, 255 patients with clinically and MRI-confirmed RCT following shoulder trauma underwent MRI between 2011 and 2024. Tears were classified as acute (< 6 weeks), subacute (6-12 weeks), or chronic (> 12 weeks) based on the reported date of trauma; acute and subacute tears were grouped as "recent". Ten predefined MRI features were independently assessed. Univariable diagnostic performance metrics were calculated for each feature. A multivariable Firth-penalized logistic regression model was developed to discriminate recent from chronic tears, with internal validation performed using bootstrap resampling.

RESULTS

Among the 255 patients (mean age 58.3 years; 65% male), intra-/peri-muscular edema (42% in recent vs 12% in chronic tears) and frayed, hyperintense tendon fibers emerged as independent predictors of recent injury (odds ratios 4.15 and 6.78, respectively). However, traditional markers of chronicity-including fatty infiltration, muscle atrophy, tendon retraction, and superior humeral head migration-showed limited discriminative value. The multivariable model demonstrated modest performance, with an ideal area under the curve (AUC) of 0.74 and an optimism-corrected AUC of 0.68. Sensitivity and specificity at the optimal threshold were 56% and 82%, respectively.

CONCLUSION

Although selected MRI findings are associated with recent RCT, an MRI-based logistic regression model provides limited accuracy for timing estimation.