Prevalence of rotator cuff tears: a systematic review and meta-analysis of observational studies

Background Rotator cuff tears are a major cause of shoulder pain, functional impairment, and reduced quality of life. However, reported prevalence estimates vary substantially across population settings, tear definitions, and diagnostic methods. This study aimed to quantify the prevalence of rotator cuff tears and identify factors contributing to variation across studies. Methods We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of rotator cuff tears. CNKI, Wanfang, VIP, PubMed, Web of Science, Embase, and the Cochrane Library were searched from database inception to December 1, 2025. Studies based on ultrasound or magnetic resonance imaging (MRI) and reporting prevalence on a per-person basis were included. Two reviewers independently performed study screening, data extraction, and quality assessment using the Agency for Healthcare Research and Quality (AHRQ) cross-sectional study appraisal tool. Statistical analyses were performed using Stata 18.0 and Python 3.13. Results Seventeen studies representing 19 independent datasets and 5,988 participants from eight countries were included. The pooled prevalence was 38.6% (95% CI , 29.2%–48.0%; I²  = 98.5%). Prevalence varied by population source, from 23.6% in asymptomatic or never-presented populations to 55.5% in symptomatic, trauma, or outpatient populations and 57.3% in specific high-exposure groups. The pooled prevalence was lower for full-thickness tears than under an any-tear definition (21.0% vs 43.8%), whereas ultrasound- and MRI-based estimates were similar (37.5% vs 40.5%). Post hoc exploratory meta-regression identified population source as the only statistically significant moderator, explaining approximately 62.1% of between-study heterogeneity. Alternative transformations yielded similar pooled estimates, while restricted analyses yielded prevalence estimates of approximately 64% in shoulder-related clinical populations. Conclusion Rotator cuff tears are common, particularly among symptomatic and high-exposure populations, underscoring the need for targeted prevention, risk assessment, and early detection. The marked variation across population settings further highlights the importance of population-specific prevalence estimates for clinical and epidemiological planning. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420251251902.