Ultrasound Shear Wave Elastography Is More Useful to Predict Irreparable Large or Massive Rotator Cuff Tears Than Magnetic Resonance Imaging Evaluation in Presurgical Planning

Purpose To determine whether preoperative shear wave elastography (SWE) can predict the feasibility of primary repair during surgery for large or massive rotator cuff tears compared with tear size and fatty infiltration on magnetic resonance imaging (MRI). Methods Patients who underwent arthroscopic surgery for large or massive rotator cuff tears were included from January 2018 to April 2024. Tear size and the Goutallier stage of fatty infiltration on MRI were measured preoperatively, as was the SWE value for the supraspinatus and infraspinatus muscles. Arthroscopic rotator cuff repair was performed when the rotator cuff stump could be pulled to the attachment site with ≤ 30 N of force (reparable group). Surgery was performed for irreparable rotator cuff tears, including superior capsular reconstruction when the torn rotator cuff stump could not be advanced to the humeral greater tuberosity with ≤ 30 N of force (irreparable group). Significant differences were recorded between the groups for SWE value, tear size, and Goutallier classification on MRI. Multivariate logistic regression analysis was used to determine the factors affecting primary repair. Results One hundred and two patients were included. Tear size on MRI was 40.2 ± 6.8 mm, Goutallier stage 2.2 ± 0.6, and SWE value 22.9 ± 8.1 kPa. Tear size, Goutallier stage, and SWE values in the irreparable group were significantly greater than those in the reparable group (all: P < .01). Multivariate logistic regression analysis showed that SWE value ( P = .01) best predicted an irreparable torn rotator cuff, compared with tear size and Goutallier stage on MRI ( P = .04 and P = .25). Conclusions The stiffness of the muscles measured preoperatively by SWE was the best predictor of whether a torn large or massive rotator cuff could be repaired intraoperatively, compared with tear size and fatty infiltration assessed on MRI. Level of Evidence Level III, retrospective diagnostic comparative case series.