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.