{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:45:29Z","timestamp":1792565129743,"version":"4.5.0"},"reference-count":65,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy, Sports Medicine, and Rehabil."],"abstract":"\n Purpose<\/jats:title>\n To develop an artificial intelligence\u2010based algorithm to predict success of nonoperative treatment in degenerative posterosuperior tears and to identify the most influential features.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients with degenerative rotator cuff tears initially treated nonoperatively were enrolled prospectively from January 2022 to November 2024. Exclusion criteria included age >75\u2009years; <24\u2009months of follow\u2010up; massive, traumatic, and partial tears; arthritic changes (Hamada >2); and severe fatty degeneration (Goutallier >2). All patients followed a standardized physiotherapy protocol and could choose surgery if symptoms persisted; failure was defined as opting for surgery. Collected variables included demographics, comorbidities (diabetes, dyslipidemia, hypertension, hypothyroidism, and smoking), magnetic resonance imaging tear characteristics (size; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine classification; associated cuff involvement; and biceps pathology), corticosteroid injection history, and functional scores (American Shoulder and Elbow Surgeons score, Subjective Shoulder Value, and the visual analog scale). First, a standard statistical analysis between groups was performed. Later, the dataset was split into a train (80%) and test (20%), and a random forest algorithm model was developed. Finally, SHapley Additive exPlanations values were computed to assess feature importance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 412 patients enrolled, 347 patients met the inclusion criteria. After 24\u2009months, 66 (19%) patients opted for surgery. Mean follow\u2010up was 30.4\u2009months (range, 24\u201032). Compared with the successful nonoperative treatment group, patients who failed treatment were younger (58.5 vs 64.6 years,\n P<\/jats:italic>\n \u2009=\u2009.001) and had higher body mass index (28.8 vs 27.2,\n P<\/jats:italic>\n \u2009=\u2009.016), greater subscapularis involvement (13.5% vs 3%,\n P<\/jats:italic>\n \u2009=\u2009.042), higher visual analog scale scores (7.7 vs 7.2,\n P<\/jats:italic>\n \u2009=\u2009.018), lower Subjective Shoulder Value (30.9 vs 38.9,\n P<\/jats:italic>\n \u2009=\u2009.003), and lower American Shoulder and Elbow Surgeons scores (40.6 vs 47.1,\n P<\/jats:italic>\n \u2009=\u2009.001). The model achieved an area under the curve of 84%, predicting success rate of the nonoperative treatment with 94% sensitivity, 62% specificity, 89% positive predictive value, and 77% negative predictive value. The most influential variables for the model were age, tear size, and pretreatment functional scores.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The artificial intelligence\u2010based algorithm accurately predicted nonoperative treatment outcomes in degenerative posterosuperior rotator cuff tears (area under the curve 0.84, sensitivity 94%). Age, tear size, and function were the main predictors.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level IV, prognostic retrospective case series.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ars2.70124","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:13:17Z","timestamp":1792563197000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Artificial Intelligence Predicts Failure of Nonoperative Treatment in Degenerative Posterosuperior Rotator Cuff Tears"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-8634","authenticated-orcid":false,"given":"Santiago","family":"Gabardo","sequence":"first","affiliation":[{"name":"Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz Universidad Aut\u00f3noma Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7881-5873","authenticated-orcid":false,"given":"Natalia","family":"Mart\u00ednez\u2010Catal\u00e1n","sequence":"additional","affiliation":[{"name":"Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz Universidad Aut\u00f3noma Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9009-7324","authenticated-orcid":false,"given":"Jos\u00e9 Mar\u00eda","family":"Belmonte Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Computer Engineering Department University of Murcia Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7265-3508","authenticated-orcid":false,"given":"Gregorio","family":"Bernab\u00e9 Garc\u00eda","sequence":"additional","affiliation":[{"name":"Computer Engineering Department University of Murcia Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Manuel","family":"Garc\u00eda Carrasco","sequence":"additional","affiliation":[{"name":"Computer Engineering Department University of Murcia Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2166-8264","authenticated-orcid":false,"given":"Cristina","family":"Delgado","sequence":"additional","affiliation":[{"name":"Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz Universidad Aut\u00f3noma Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Valencia\u2010Mora","sequence":"additional","affiliation":[{"name":"Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz Universidad Aut\u00f3noma Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3516-5043","authenticated-orcid":false,"given":"Gonzalo","family":"Luengo\u2010Alonso","sequence":"additional","affiliation":[{"name":"Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz Universidad Aut\u00f3noma Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6054-6078","authenticated-orcid":false,"given":"Emilio","family":"Calvo","sequence":"additional","affiliation":[{"name":"Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz Universidad Aut\u00f3noma Madrid 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