Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis

Abstract

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results: In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears ( P = .13-.81). Conclusion: For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.

Collagen and platelet-rich plasma in partial-thickness rotator cuff injuries. Friends or only indifferent neighbours? Randomised controlled trial

“…In the IT or OF type of injury, the measurement was performed at the thickest point of RC (follow-up estimated tendency for reduction of inflammatory and oedematous overgrowth of the RC as a sign of regeneration). It should be emphasised that ultrasound examination of the shoulder, especially RC thickness, which was performed according to the standards and based on the current state of the art, is highly sensitive and specific for the diagnosis of supraspinatus tears and presents equivalent capability to MRI in the diagnosis of both full- and partial-thickness RC tears (PT-RCTs) [ 22 ].…”

Diagnostic sensitivity of ultrasound of the supraspinatus tendon when compared to magnetic resonance imaging prior to arthroscopy: A retrospective study

“…However, because arthroscopy involves an anaesthetic and a surgical procedure, it is not appropriate to be used as the first line of assessment 9 . Although MRI remains the preferred imaging modality for shoulder assessment, 1–3 USS is emerging as a cost‐effective, reliable, and convenient alternative due to continued improvement in transducer resolution and consistent education 24,26,27 . While the results of our research may impact on the diagnostic imaging choices prior to supraspinatus arthroscopy with USS being used as an alternative to MRI, our study suggests, practices should audit USS to see if these results concur generally.…”

“…Recent meta-analysis published in 2020 and 2021, 27,30 found good correlation between MRI and USS for FTT though a lower sensitivity for both modalities compared to arthroscope for characterising PTT. 27,30 These results appear to be broadly consistent with earlier systemic reviews.…”

“…Recent meta-analysis published in 2020 and 2021, 27,30 found good correlation between MRI and USS for FTT though a lower sensitivity for both modalities compared to arthroscope for characterising PTT. 27,30 These results appear to be broadly consistent with earlier systemic reviews. With advances in technologies, MRI and USS have together shown significant improvements in the detection of both PTT and FTT.…”

Subscapularis tendon tear classification and diagnosis: A systemic review and meta-analysis

“…Ultrasonography is among other imaging techniques for the diagnosis of subscapularis tendon disorders . Although there are numerous studies on the accuracy of ultrasonography for diagnosing rotator cuff tendon tears particularly supraspinatus tendon tears, there are limited studies on the accuracy of ultrasonography in diagnosing subscapularis tendon tears ( 32 ). A meta-analysis conducted by Farooqi et al on the diagnostic accuracy of ultrasonography for rotator cuff tears showed that ultrasonography has a more diagnostic accuracy for bicep tendon tears (93%) and supraspinatus tendon tears (83%) compared to subscapularis tendon tears (76%).…”