Shear-wave elastography in rotator cuff tears: a systematic review of measurement properties, tissue-stiffness findings, and clinical interpretability.

Abstract

Objectives: Shear-wave elastography (SWE) may quantify rotator cuff mechanical properties, but its measurement performance and clinical interpretability remain incompletely established. This work sought to synthesize evidence on the feasibility, measurement properties, and interpretability of rotator cuff SWE in adults with rotator cuff tears (RCTs).

Materials and methods: PubMed, Scopus, and Web of Science were searched. Eligible studies were in vivo primary studies in adults (≥ 18 years) with suspected or symptomatic rotator cuff disease in whom partial- or full-thickness RCT was confirmed by an imaging or surgical reference standard, including conventional ultrasound, MRI, CT, or arthroscopy, and/or studies including clinically relevant comparator shoulders or asymptomatic controls. Studies had to use ultrasound SWE with quantitative outputs, including shear-wave speed/velocity or modulus, in the supraspinatus tendon and/or rotator cuff muscles.

Results: Thirteen SWE studies were retained from 6273 records. Two primarily assessed reliability/repeatability. Intra-rater reproducibility was high in the primary reliability studies, including ICCs > 0.87 and 0.96, whereas inter-rater reproducibility was lower and variable, ranging from ICCs > 0.73 to 0.45. Eleven studies contributed construct-validity or known-groups evidence, one provided strict criterion-validity evidence against intraoperative passive stiffness, and two provided longitudinal postoperative evidence. SWE findings varied across tissue targets, devices, regions of interest, arm positions, comparators, and reference standards. Only one study explicitly defined chronicity, and direct postoperative/prognostic evidence was limited.

Conclusions: SWE appears useful as a complementary quantitative imaging tool for selected rotator cuff tissue-characterization and measurement-property applications. However, inter-rater reproducibility, measurement error, chronicity assessment, and prognostic validity remain insufficiently established.

Key points: Question Can shear-wave elastography (SWE) address the unmet need for reliable quantitative rotator cuff tissue assessment beyond conventional imaging in adults with tears? Findings Thirteen studies showed high intra-rater reproducibility but variable inter-rater reproducibility. Evidence for chronicity assessment and prognosis remained sparse and heterogeneous. Clinical relevance SWE may complement ultrasound or MRI by quantifying selected rotator cuff mechanical properties, but current evidence does not justify using it alone to determine tear chronicity, reparability, or prognosis.