Rotator Cuff Tear-induced Changes in Tendon Structure and Mechanics Measured by Quantitative Magnetic Resonance Imaging

Mason J Garcia; Giovanni Intermesoli; Alberto Lalli; Gabriel Landi; Dev R Mehrotra; Erik E Ersland; Arun J Ramappa; Joseph P DeAngelis; Aaron Grant; Michael B Albro; Umile Giuseppe Longo; Ara Nazarian

doi:10.1007/s10439-025-03849-1

Rotator Cuff Tear-induced Changes in Tendon Structure and Mechanics Measured by Quantitative Magnetic Resonance Imaging

Ann Biomed Eng. 2025 Nov;53(11):2996-3008. doi: 10.1007/s10439-025-03849-1. Epub 2025 Sep 20.

Authors

Mason J Garcia^{1

2}, Giovanni Intermesoli^{3

4}, Alberto Lalli^{3

4}, Gabriel Landi¹, Dev R Mehrotra⁵, Erik E Ersland², Arun J Ramappa^{1

6}, Joseph P DeAngelis^{1

6}, Aaron Grant⁷, Michael B Albro^{2

5}, Umile Giuseppe Longo^#^{3

4}, Ara Nazarian^#^{8

9

10

11}

Affiliations

¹ Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02215, USA.
² Mechanical Engineering Department, Boston University, Boston, MA, USA.
³ Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
⁴ Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.
⁵ Department of Biomedical Engineering, Boston University, Boston, MA, USA.
⁶ Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁷ Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁸ Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02215, USA. anazaria@bidmc.harvard.edu.
⁹ Mechanical Engineering Department, Boston University, Boston, MA, USA. anazaria@bidmc.harvard.edu.
¹⁰ Department of Biomedical Engineering, Boston University, Boston, MA, USA. anazaria@bidmc.harvard.edu.
¹¹ Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia. anazaria@bidmc.harvard.edu.

^# Contributed equally.

PMID: 40975728
DOI: 10.1007/s10439-025-03849-1

Abstract

Introduction: Rotator cuff (RC) tears are prevalent degenerative injuries associated with progressive loss of shoulder function. Although MRI is routinely used for diagnosing RC tears, the relationship between imaging biomarkers and tendon mechanical function remains poorly understood. This study investigates whether quantitative MRI (qMRI), particularly T2 relaxation time, reflects structural and mechanical changes in supraspinatus tendons with RC tears.

Methods: Twenty-four human cadaveric supraspinatus tendons (10 intact, 14 torn) were analyzed. Mechanical testing was performed to assess structural and material properties. T2 mapping using a 9.4T MRI scanner was employed to determine relaxation times. Raman spectroscopy and multiphoton imaging were used to assess biochemical composition and collagen organization.

Results: Torn tendons showed significantly reduced stiffness (p = 0.035) and failure force (p = 0.015) compared to intact tendons. T2 relaxation times were significantly elevated in the torn group (23.7 ± 3.5 ms vs. 20.6 ± 3.3 ms; p = 0.035), with higher heterogeneity and 90th percentile values. T2 metrics correlated strongly with mechanical properties (stiffness: r_s = - 0.84, p = 0.002; failure force: r_s = - 0.86, p = 0.002) and tear area (r_s = - 0.79, p = 0.004). Raman spectroscopy showed reduced proline and hydroxyproline spectral biomarkers in torn tendons (p < 0.02), which correlated with mechanical weakening. Multiphoton imaging revealed significant collagen disorganization and damage in torn tendons.

Discussion: This study demonstrates that T2 relaxation time is a sensitive non-invasive biomarker of tendon mechanical health and collagen structure in RC tears. These findings support the clinical utility of qMRI in assessing tendon pathology and guiding treatment strategies.

Keywords: Multiphoton imaging; Quantitative MRI (qMRI); Raman spectroscopy; Rotator cuff tear; Supraspinatus tendon; T2 relaxation time; Tendon mechanics.

MeSH terms

Adult
Aged
Aged, 80 and over
Biomechanical Phenomena
Collagen / metabolism
Female
Humans
Magnetic Resonance Imaging*
Male
Middle Aged
Rotator Cuff Injuries* / diagnostic imaging
Rotator Cuff Injuries* / physiopathology
Rotator Cuff* / diagnostic imaging
Rotator Cuff* / pathology
Rotator Cuff* / physiopathology
Tendon Injuries* / diagnostic imaging
Tendon Injuries* / physiopathology

Substances

Collagen