JSES - 2026-09-10 - Journal Article
Shear-Wave Elastography for Assessing the Histological Characteristics of Torn Rotator Cuff Tendons.
Chen V, Beretov J, Bilog AM, Changbean Kang E, Sima S, Bilbrough J, Shenouda M, Hackett L, Hawa A, Millar N, Murrell GAC
Topics
Key Takeaway
Preoperative SWE stiffness correlates with collagen disorganization (ρ=0.56, p=0.02) and cellularity grading (ρ=0.45, p=0.04) in torn supraspinatus tendons, but not with overall Bonar score.
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Summary
This study asked whether preoperative SWE stiffness values correlate with histopathological features scored by the Bonar system in torn supraspinatus tendons. Intraoperative biopsies from partial and full-thickness tears were stained for tenocyte morphology, cellularity, vascularity, collagen organization, and glycosaminoglycan content, then correlated with preoperative SWE. Tendons with mixed hyper/hypocellularity had significantly higher SWE values than uniformly hypercellular tendons (Mann-Whitney U=89.0, p=0.04), and SWE increased monotonically with collagen disorganization (Jonckheere-Terpstra Z=2.67, p=0.01), but no association was found with overall Bonar score, tenocyte morphology, ground substance, or vascularity.
Key Limitation
The sample size of 22 is insufficient to validate SWE against the composite Bonar score or to stratify findings by tear size and chronicity, which are the clinically actionable variables.
Original Abstract
BACKGROUND
Shear wave elastography (SWE) is an imaging modality for assessing torn rotator cuff tendons applicable to both the preoperative and postoperative setting. SWE values increase following surgical repair, and lower values have been associated with factors linked to impaired tendon healing, including increasing age and greater tear size. However, the relationship between SWE and the tendons underlying histological characteristics remains unclear. This study therefore aimed to determine whether SWE values were associated with tendon histological features assessed by the Bonar score in torn rotator cuffs.
METHODS
The stiffness (kPa) of the supraspinatus tendon was assessed pre-operatively using SWE. Samples were collected intraoperatively from the torn edge of the supraspinatus tendon in both partial and full thickness tears. Sections were stained with Hematoxylin and Eosin to assess tenocyte morphology, cellularity, vascularisation and collagen organization. Sections were also stained with Alcian blue (pH2.5) for identification of areas rich in glycosaminoglycans.
RESULTS
Twenty-two torn supraspinatus tendon samples were analysed. Tendons exhibiting mixed hypercellular and hypocellular regions demonstrated significantly higher SWE values than uniformly hypercellular tendons (Mann-Whitney U = 89.0, Z = 2.04, p = 0.04). A Jonckheere Terpstra test demonstrated a significant monotonic increase in SWE values with increasing collagen disorganisation (Z = 2.67, p = 0.01). A secondary analysis of SWE values demonstrated a moderate positive correlation with cellularity grading (ρ = 0.45, p = 0.04) and collagen grading (ρ = 0.56, p = 0.02). No significant associations were observed between SWE values and tenocyte morphology, ground substance, vascularity, or overall Bonar score.
CONCLUSION
Shear wave elastography demonstrated associations with specific histopathological features of torn supraspinatus tendons, with greater measured stiffness observed in tendons exhibiting mixed hyper- and hypocellularity and increased collagen disorganisation. These findings support SWE as a potential non-invasive marker of specific histopathological features in the supraspinatus tendon.