Ultrasound vs. MRI Assessment of Rotator Cuff Tear Severity: A Systematic Review and Meta-Analysis of Supraspinatus Tears

Objective: Rotator cuff tears involving the supraspinatus tendon are a common cause of shoulder pain. Ultrasound (US) is accessible, dynamic, and lower cost than MRI, but diagnostic performance may vary by tear severity, operator expertise. This systematic review and meta-analysis compared the US with MRI for supraspinatus tear detection. Methods: MEDLINE, Embase, Scopus, and CINAHL Plus were searched for studies published from January 2015 to June 2026. Study quality was assessed using QUADAS-2. Diagnostic outcomes included sensitivity, specificity, accuracy, PPV, NPV. Meta-analyses were performed separately for any, partial-thickness, and full-thickness tears when complete 2 x 2 data were available. Results: 23 studies comprising 1,452 participants were included. US demonstrated stronger and more consistent performance for full-thickness than partial-thickness tears. Mean sensitivity, specificity, and accuracy were 88.5%, 95.2%, and 93.4%, respectively, for full-thickness tears, compared with 71.5%, 91.5%, and 79.2% for partial-thickness tears. HSROC analysis showed pooled sensitivity and specificity of 96% and 76% for any tear, 94% and 80% for partial-thickness tears, and 96% and 98% for full-thickness tears. Agreement measures also generally favored full-thickness tears. Operator expertise, study quality varied, and only one study evaluated a handheld ultrasound system. Conclusion: Ultrasound demonstrates strong diagnostic performance for supraspinatus tears, particularly full-thickness tears, while partial-thickness tears remain more challenging. Given the high observed sensitivity, well-performed US may serve as a practical first-line modality to rule out full-thickness tears, with MRI remaining complementary for equivocal partial-thickness tears, associated pathology, and preoperative assessment.