Our results suggest that clinical examination by specialists can rule out the presence of a RCT, and that either MRI or ultrasound could equally be used for detection of full-thickness RCTs. Although still not by any means accurate, ultrasound may be better at picking up partial tears. Given the large differential in the cost of the two procedures, the implication from current evidence is that ultrasound is the more cost-effective test to use in a specialist hospital setting for identification of full-thickness tears. Whether or not these results are transferable to settings with lower prevalence, different spectra of disease and less-specialised clinicians, such as in primary care, remains to be determined.