Vol. 11, Issue 2 (2025)

Background: Avulsion injuries of the rotator cuff present significant challenges in orthopedic practice. While advanced imaging has enhanced diagnostic capabilities, the relationship between morphometric parameters of these injuries and functional outcomes remains poorly understood.

Methods: This prospective observational study included 94 patients (57 males, 37 females; mean age 48.6±11.3 years) with radiologically confirmed avulsion injuries of the rotator cuff. Comprehensive clinical assessment included Visual Analog Scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Constant-Murley score. Radiological evaluation comprised standardized radiographs, 3.0-Tesla MRI, and in selected cases, MR arthrography and ultrasonography. Morphometric parameters measured included avulsion dimensions, displacement distance, gap area, tissue retraction, muscle atrophy, and fatty infiltration index. Statistical analysis examined correlations between morphometric parameters and functional outcomes.

Results: Subscapularis avulsions demonstrated the largest dimensions and greatest displacement compared to supraspinatus and infraspinatus injuries (p<0.05). Displacement distance and tissue retraction grade showed the strongest correlations with functional outcomes (r=0.56-0.67, p<0.001). Multiple regression analysis identified displacement distance (β=0.36, p<0.001) and tissue retraction grade (β=0.31, p<0.001) as the strongest independent predictors of DASH scores (R²=0.73). Chronic injuries exhibited significantly worse morphometric parameters than acute cases, particularly regarding fatty infiltration (1.69±0.78 vs. 0.83±0.52, p<0.001). Radiological measurements demonstrated excellent correlation with intraoperative findings (ICC=0.83-0.92).

Conclusion: Morphometric analysis of avulsion injuries provides valuable insights into structure-function relationships in rotator cuff pathology. Displacement distance and tissue retraction grade represent the most significant predictors of functional disability, with chronicity substantially influencing morphometric parameters. These findings may guide clinical decision-making regarding treatment timing and approach.