- Email: [email protected]
Frequency and Complications after Operative Fixation of Clavicle Fractures
e36
ASES Abstracts
Fig. 1 True AP (A) view of shoulder depicting the measurement of HGA-SI by drawing a best-fit circle on the humeral head with a line parallel from the center of the circle to the glenoid center peg. The HGA-SI was determined as the difference between the line and center peg of the glenoid (arrow). The axillary (B) view of a shoulder depicting measurement of glenoid retroversion determined by drawing a line parallel to the body of the scapula similar to Friedman’s technique in CT, and a line (the glenoid axis – dotted line) overlapping the center peg of the glenoid (black arrow). The angle between these two lines (*) represented the amount of version of the glenoid.
Fig. 2 Grade 1 (A) APG has marked osteolysis around the center peg of the glenoid component as identified by the radioopaque marker. Grade 2 (B) changes are defined as bone integration to the edges of the flanges of the center peg, but not within. Grade 3 (C) changes are defined as bone integration within the flanges of the center peg. posterior bone loss. Current standard surgical methods and components appear to be insufficient to correct excessive preoperative glenoid retroversion.
26 SURVIVORSHIP OF HEMIARTHROPLASTY WITH CONCENTRIC GLENOID REAMING FOR GLENOHUMERAL ARTHRITIS IN THE YOUNG ACTIVE PATIENT Kenneth A. Kearns, MD, Peter S. Johnston, MD, Mark D. Lazarus, MD, Charles L. Getz, MD, Gerald R. Williams Jr, MD, Rothman Institute, Philadelphia, Pennsylvania, USA Introduction: Operative interventions for the young active patient with glenohumeral arthritis are limited. Hemiarthroplasty with concentric glenoid reaming, Ream and Run, is one option with the originator of the procedure reporting good long-term results and no revisions within the first year. The purpose of this study is to be the first besides the original author to report results with the Ream and Run procedure, comparing survivorship and patient outcomes. Methods: 36 patients underwent 38 hemiarthroplasties with concentric glenoid reaming for degenerative arthritis, posttraumatic arthritis, hypoplastic glenoids, instability arthropathy and chondrolysis by two senior surgeons between 2007-2010. There were 35 males with a mean age of 48.0 years (19.562.3). 32 patients had eccentric glenoid bone loss. 17 patients had the reaming performed with reamers that were 2 mm larger than the prosthetic humeral head diameter and the remainder had standard glenoid reamers. Two patients were lost to followup. The remaining 34 patients (36 shoulders), were retrospectively
J Shoulder Elbow Surg October 2013
evaluated from 1.2 years to 4.9 years (average 2.3 years). Survivorship of the procedure and patient outcomes were analyzed with PENN, Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) scores. Results: 5 patients (13.8 %) underwent revision surgery at an average of 0.9 years (0.7-1.2) secondary to continued pain. 4 were converted to total shoulder arthroplasty and 1 underwent revison hemiarthroplasty with a capsular release. Based on post-op PENN scores, 9 patients had excellent results (90-100), 6 had good results (80-89), 5 had fair results (70-79) and 11 had poor results (<70). Of those that required revision surgery or had poor results, 13/16 had eccentric bone loss, 7/16 used standard reamers, 9/16 had prior surgery and 4/16 had a diagnosis other than osteoarthritis, respectively. SANE scores at latest follow up were 65.2 (1-95) and SST scores were 78.7 (17-100). Conclusion: Hemiarthroplasty with concentric glenoid reaming in the young active patient provides modest improvements in pain and function. Our survivorship is similar to that presented by the original author; however, our findings indicate patients require revision surgery on average less than 1 year postoperative as compared to previous reports of 2 years in the same patient population.
28 SURGICAL TREATMENT OF CHRONIC ACROMIONCLAVICULAR DISLOCATION WITH BIOLOGIC GRAFT VS. ARTIFICIAL LIGAMENT AT LONG TERM FOLLOW-UP Paolo Paladini, MD, Giovanni Merolla, MD, Francesco Fauci, Fabrizio Campi, MD, Giuseppe Porcellini, MD, Unit of Shoulder and Elbow Surgery, ‘‘D. Cervesi’’ Hospital, Cattolica, Italy Introduction: Chronic acromionclavicular (A/C) dislocation is a complete loss of articular contact that follows to conservative management or failed surgical treatment. While there is a consensus for conservative management of type I and II, the surgical approach for the type III to V is still debated. Aim: Comparison of clinical and radiographic outcomes after surgical treatment of chronic A/C joint dislocation with biologic (group A) vs synthetic (group B) system of fixation. Methods: 40 patients (M/F: 25/15; mean age: 35 years (SD:3.2; dominant shoulder: 28 cases) were prospectly enrolled and randomly assigned in the ‘‘biologic’’ (20 subjects) and ‘‘synthetic’’ (20 subjects) group. Previous surgery was performed in 11 cases. 14 cases (35%) were type III and 26 (65%) cases type IV. Overall patients were assessed with Constant-Murley score and modified UCLA score. X-ray were performed to depict: A/C joint stability in the coronal and axial plane, coracoclavicular ossifications, A/C joint osteoarthritis, distal clavicular osteolysis. Results: Patients of the group A achieved better clinical scores than those of the group B at 1 year (p < 0.05) and at 4 years (p < 0.05). Lower scores were found in the three cases (group A: 1; group B: 2) with complete postoperative A/C joint dislocation. No significant correlations were found with other radiographic parameters. Conclusion: Biologic graft give better clinical and radiographic outcomes than synthetic ligament in chronic A/C joint instability. From our data arise the need to improve the system of fixation on the clavicle, that is the weak point of both procedures.
30 FREQUENCY AND COMPLICATIONS AFTER OPERATIVE FIXATION OF CLAVICLE FRACTURES Ronald A. Navarro, MD, Jonathan D. Gelber, MD, John J. Harrast, MS, John G. Seiler III, MD, Kent R. Jackson, MD, Department of Orthopaedic Surgery, Kaiser Permanente South Bay, Harbor City, California; Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, California; American Board of Orthopaedic Surgery, Hinsdale, Illinois; Georgia Hand, Shoulder, and Elbow, Atlanta, Georgia Background: The purpose of this study was to analyze whether a recent trend in evidence supporting operative treatment of clavicle fractures is matched with an increase in operative fixation rates, as
J Shoulder Elbow Surg Volume 22, Number 10
well as complication rates. Methods: The American Board of Orthopaedic Surgery (ABOS) database was reviewed for cases with CPT code 23515 (ORIF clavicle) from 1999-2010. The procedure rate for each year was calculated and the number of procedures in total and the number of procedures for each candidate performing clavicle ORIF were calculated to determine if there had been a change in the frequency of ORIF for clavicle fractures. Complication and outcome data was also reviewed. Results: In 2010 vs. 1999, there were statistically significant increases in both the mean number of clavicle ORIF performed among all candidates (0.89 vs. 0.13; p<0.0001) and the mean number of clavicle ORIF per candidate performing clavicle ORIF (2.47 vs. 1.20 p<0.0473). There was a significant difference between the percentage of Part II candidates performing clavicle ORIF from the start to the end of the study (36% vs. 11% ; p<0.0001). There was a significant increase in the clavicle ORIF percentage of total cases (0.74% vs. 0.11%; p<0.0001). Of those candidates performing clavicle ORIF, there was a statistically significant increase in the percentage of total cases that were clavicle ORIF (1.76% vs. 0.85%; p<0.0001). The most common complication was hardware failure (4%). Pain was decreased or absent and deformity was improved or normal in 95% of patients. Function was normal or improved in 88%. Conclusion: Based on the dataset of the ABOS, the rate of open treatment for clavicle fractures has increased dramatically since 1999 with a low complication rate. The increase in practice patterns may be due to clinical trials suggesting superior outcomes in patients treated with operative stabilization1. 1. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. JBJS. Am. 2007;89-1:1-10.
31 THE EFFECT OF CORACOCLAVICULAR FIXATION ON THE STABILITY OF TYPE IIB DISTAL CLAVICLE FRACTURES FIXED WITH A SUPERIOR LOCKING PLATE AND SCREWS Wes Madsen, MD, Zaneb Yaseen, MD, Russell Lafrance, MD, Tony Chen, PhD, Hani Awad, PhD, Michael Maloney, MD, Ilya Voloshin, MD, Department of Orthopaedics at the University of Rochester Medical Center, Rochester, New York, USA Purpose: Surgical treatment of distal clavicle fractures is controversial. The role of coracoclavicular (CC) fixation on biomechanical stability in fractures fixed with plate and screws is not known. Our hypothesis is that coracoclavicular fixation will add stability to type IIB distal clavicle fractures treated with a superior locking plate and screws by neutralizing supero-inferior translational forces in the coronal plane. Materials and Methods: Twelve fresh frozen cadaveric specimens were used to create type IIB distal clavicle fractures in consistent manner. Matched pairs and DEXA scans were used to ensure similar bone quality. Group I (6 specimens) consisted of specimens stabilized with a superior precontoured distal clavicle locking plate, screws and supplemental coracoclavicular fixation using a suture anchor device. Group II (6 matched contralateral specimens) was the same construct without coracoclavicular fixation. Each specimen was cyclically loaded in the coronal plane at 40 to 80 N for 17,500 cycles (equivalent to cyclic loading on the protected shoulder in ambulating patient for 1 week). Load to failure testing up to 1000N was then performed on the specimens that did not fail cyclical loading. Outcome measures included the mode of failure and either the number of cycles or maximum load required to create 10 mm of displacement in the construct. Results: All specimens (12/12) completed the cyclic testing without failure and underwent load to failure testing. Group 1 specimens with CC fixation failed at a mean of 817 N (range, 675-980 N), whereas group 2 specimens without CC fixation failed at a mean of 438 N (range, 300-640 N) (p¼0.005). All but two specimens in group 1 (4/6) failed by anchor pull out from the coracoid. One specimen did not fail at the maximal load the materials testing machine was capable of exerting (1000 N). One specimen failed by distal clavicle fracture fragment fragmentation. No coracoid
ASES Abstracts
e37
fractures occurred. Group II specimens failed by distal clavicle fracture fragment fragmentation (3) and acromioclavicular (AC) joint displacement of greater than ten millimeters (1). Two group II specimens did not fail at the maximal load of the materials testing machine. Conclusion: CC fixation is a useful adjunct to augment plate fixation in type IIB distal clavicle fractures.
32 ADAPTING TO A NEW ERA OF PATIENT SATISFACTION DRIVEN REIMBURSEMENT: SETTING PATIENTS’ EXPECTATIONS FOR RANGE OF MOTION AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR Joshua D. Harris, MD, Amy L. Ravindra, MD, Grant L. Jones, MD, R. Bryan Butler, MD, Julie Y. Bishop, MD, The Ohio State University Medical Center, the Ohio State University College of Medicine, and the Ohio State University Sports Medicine Center, Columbus, Ohio, USA Objectives: The primary goal of this study is to determine if there is a difference in pre- and postoperative ROM between small, medium, and large isolated rotator cuff tears treated with arthroscopic rotator cuff repair. Secondarily, we wanted to determine if early stiffness resolves, and at what time point postoperatively motion is restored. We hope that this information can be used to advise and reassure patients on what is normal, and to promote realistic patient expectations at frequent time points postoperatively. Methods: A retrospective case series of patients treated with arthroscopic rotator cuff repair is reported. Two shoulder fellowship-trained surgeons performed 804 repairs between September 2006 and July 2010. All repairs with concomitant procedures (other than subacromial decompression, biceps tenotomy, or debridement) were excluded. Three groups were analyzed: 1) Small tears (defined as a partial or full-thickness tear less than one centimeter in size); 2) Medium tears (defined as full-thickness tears between one and three centimeters in size); and 3) Large tears (defined as full-thickness tears greater than three centimeters in size). After application of exclusion criteria, there were 274 patients analyzed for this study with up to one year follow-up. Active and passive range-of-motion for both groups was collected pre- and post-operatively at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months. Continuous data was reported as mean +/- standard deviation. Groups of data were compared using a two-tailed student’s t-test assuming a normal distribution. Results: At all points pre-op and post-op large tears were significantly stiffer than the small tears (p < 0.0055 for all time points) in external rotation (ER). The large tears were also significantly stiffer in ER than the medium tears at preoperatively and at 3, 6, and 12 months (p < 0.05). Small, medium, and large tears do not regain full (preoperative) ER ROM until 1 year postoperative. For ROM in forward elevation, large tears were significantly stiffer than small tears for all points from 6 weeks through 1 year postoperatively (p < 0.05). Full (preoperative) motion in FE is restored at 3 months for small tears and at 6 month for medium and large tears. Conclusions: Significant differences in shoulder motion were observed following arthroscopic repair of small, medium, and large isolated rotator cuff tears. Large tears are stiffer than small at all time points in external rotation. It takes one year to restore external rotation for small and medium tears, and large tears have residual stiffness in ER at one year. Full forward elevation is restored earlier (3 months for small and 6 months for medium and large tears).
ASES Abstracts
Fig. 1 True AP (A) view of shoulder depicting the measurement of HGA-SI by drawing a best-fit circle on the humeral head with a line parallel from the center of the circle to the glenoid center peg. The HGA-SI was determined as the difference between the line and center peg of the glenoid (arrow). The axillary (B) view of a shoulder depicting measurement of glenoid retroversion determined by drawing a line parallel to the body of the scapula similar to Friedman’s technique in CT, and a line (the glenoid axis – dotted line) overlapping the center peg of the glenoid (black arrow). The angle between these two lines (*) represented the amount of version of the glenoid.
Fig. 2 Grade 1 (A) APG has marked osteolysis around the center peg of the glenoid component as identified by the radioopaque marker. Grade 2 (B) changes are defined as bone integration to the edges of the flanges of the center peg, but not within. Grade 3 (C) changes are defined as bone integration within the flanges of the center peg. posterior bone loss. Current standard surgical methods and components appear to be insufficient to correct excessive preoperative glenoid retroversion.
26 SURVIVORSHIP OF HEMIARTHROPLASTY WITH CONCENTRIC GLENOID REAMING FOR GLENOHUMERAL ARTHRITIS IN THE YOUNG ACTIVE PATIENT Kenneth A. Kearns, MD, Peter S. Johnston, MD, Mark D. Lazarus, MD, Charles L. Getz, MD, Gerald R. Williams Jr, MD, Rothman Institute, Philadelphia, Pennsylvania, USA Introduction: Operative interventions for the young active patient with glenohumeral arthritis are limited. Hemiarthroplasty with concentric glenoid reaming, Ream and Run, is one option with the originator of the procedure reporting good long-term results and no revisions within the first year. The purpose of this study is to be the first besides the original author to report results with the Ream and Run procedure, comparing survivorship and patient outcomes. Methods: 36 patients underwent 38 hemiarthroplasties with concentric glenoid reaming for degenerative arthritis, posttraumatic arthritis, hypoplastic glenoids, instability arthropathy and chondrolysis by two senior surgeons between 2007-2010. There were 35 males with a mean age of 48.0 years (19.562.3). 32 patients had eccentric glenoid bone loss. 17 patients had the reaming performed with reamers that were 2 mm larger than the prosthetic humeral head diameter and the remainder had standard glenoid reamers. Two patients were lost to followup. The remaining 34 patients (36 shoulders), were retrospectively
J Shoulder Elbow Surg October 2013
evaluated from 1.2 years to 4.9 years (average 2.3 years). Survivorship of the procedure and patient outcomes were analyzed with PENN, Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) scores. Results: 5 patients (13.8 %) underwent revision surgery at an average of 0.9 years (0.7-1.2) secondary to continued pain. 4 were converted to total shoulder arthroplasty and 1 underwent revison hemiarthroplasty with a capsular release. Based on post-op PENN scores, 9 patients had excellent results (90-100), 6 had good results (80-89), 5 had fair results (70-79) and 11 had poor results (<70). Of those that required revision surgery or had poor results, 13/16 had eccentric bone loss, 7/16 used standard reamers, 9/16 had prior surgery and 4/16 had a diagnosis other than osteoarthritis, respectively. SANE scores at latest follow up were 65.2 (1-95) and SST scores were 78.7 (17-100). Conclusion: Hemiarthroplasty with concentric glenoid reaming in the young active patient provides modest improvements in pain and function. Our survivorship is similar to that presented by the original author; however, our findings indicate patients require revision surgery on average less than 1 year postoperative as compared to previous reports of 2 years in the same patient population.
28 SURGICAL TREATMENT OF CHRONIC ACROMIONCLAVICULAR DISLOCATION WITH BIOLOGIC GRAFT VS. ARTIFICIAL LIGAMENT AT LONG TERM FOLLOW-UP Paolo Paladini, MD, Giovanni Merolla, MD, Francesco Fauci, Fabrizio Campi, MD, Giuseppe Porcellini, MD, Unit of Shoulder and Elbow Surgery, ‘‘D. Cervesi’’ Hospital, Cattolica, Italy Introduction: Chronic acromionclavicular (A/C) dislocation is a complete loss of articular contact that follows to conservative management or failed surgical treatment. While there is a consensus for conservative management of type I and II, the surgical approach for the type III to V is still debated. Aim: Comparison of clinical and radiographic outcomes after surgical treatment of chronic A/C joint dislocation with biologic (group A) vs synthetic (group B) system of fixation. Methods: 40 patients (M/F: 25/15; mean age: 35 years (SD:3.2; dominant shoulder: 28 cases) were prospectly enrolled and randomly assigned in the ‘‘biologic’’ (20 subjects) and ‘‘synthetic’’ (20 subjects) group. Previous surgery was performed in 11 cases. 14 cases (35%) were type III and 26 (65%) cases type IV. Overall patients were assessed with Constant-Murley score and modified UCLA score. X-ray were performed to depict: A/C joint stability in the coronal and axial plane, coracoclavicular ossifications, A/C joint osteoarthritis, distal clavicular osteolysis. Results: Patients of the group A achieved better clinical scores than those of the group B at 1 year (p < 0.05) and at 4 years (p < 0.05). Lower scores were found in the three cases (group A: 1; group B: 2) with complete postoperative A/C joint dislocation. No significant correlations were found with other radiographic parameters. Conclusion: Biologic graft give better clinical and radiographic outcomes than synthetic ligament in chronic A/C joint instability. From our data arise the need to improve the system of fixation on the clavicle, that is the weak point of both procedures.
30 FREQUENCY AND COMPLICATIONS AFTER OPERATIVE FIXATION OF CLAVICLE FRACTURES Ronald A. Navarro, MD, Jonathan D. Gelber, MD, John J. Harrast, MS, John G. Seiler III, MD, Kent R. Jackson, MD, Department of Orthopaedic Surgery, Kaiser Permanente South Bay, Harbor City, California; Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, California; American Board of Orthopaedic Surgery, Hinsdale, Illinois; Georgia Hand, Shoulder, and Elbow, Atlanta, Georgia Background: The purpose of this study was to analyze whether a recent trend in evidence supporting operative treatment of clavicle fractures is matched with an increase in operative fixation rates, as
J Shoulder Elbow Surg Volume 22, Number 10
well as complication rates. Methods: The American Board of Orthopaedic Surgery (ABOS) database was reviewed for cases with CPT code 23515 (ORIF clavicle) from 1999-2010. The procedure rate for each year was calculated and the number of procedures in total and the number of procedures for each candidate performing clavicle ORIF were calculated to determine if there had been a change in the frequency of ORIF for clavicle fractures. Complication and outcome data was also reviewed. Results: In 2010 vs. 1999, there were statistically significant increases in both the mean number of clavicle ORIF performed among all candidates (0.89 vs. 0.13; p<0.0001) and the mean number of clavicle ORIF per candidate performing clavicle ORIF (2.47 vs. 1.20 p<0.0473). There was a significant difference between the percentage of Part II candidates performing clavicle ORIF from the start to the end of the study (36% vs. 11% ; p<0.0001). There was a significant increase in the clavicle ORIF percentage of total cases (0.74% vs. 0.11%; p<0.0001). Of those candidates performing clavicle ORIF, there was a statistically significant increase in the percentage of total cases that were clavicle ORIF (1.76% vs. 0.85%; p<0.0001). The most common complication was hardware failure (4%). Pain was decreased or absent and deformity was improved or normal in 95% of patients. Function was normal or improved in 88%. Conclusion: Based on the dataset of the ABOS, the rate of open treatment for clavicle fractures has increased dramatically since 1999 with a low complication rate. The increase in practice patterns may be due to clinical trials suggesting superior outcomes in patients treated with operative stabilization1. 1. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. JBJS. Am. 2007;89-1:1-10.
31 THE EFFECT OF CORACOCLAVICULAR FIXATION ON THE STABILITY OF TYPE IIB DISTAL CLAVICLE FRACTURES FIXED WITH A SUPERIOR LOCKING PLATE AND SCREWS Wes Madsen, MD, Zaneb Yaseen, MD, Russell Lafrance, MD, Tony Chen, PhD, Hani Awad, PhD, Michael Maloney, MD, Ilya Voloshin, MD, Department of Orthopaedics at the University of Rochester Medical Center, Rochester, New York, USA Purpose: Surgical treatment of distal clavicle fractures is controversial. The role of coracoclavicular (CC) fixation on biomechanical stability in fractures fixed with plate and screws is not known. Our hypothesis is that coracoclavicular fixation will add stability to type IIB distal clavicle fractures treated with a superior locking plate and screws by neutralizing supero-inferior translational forces in the coronal plane. Materials and Methods: Twelve fresh frozen cadaveric specimens were used to create type IIB distal clavicle fractures in consistent manner. Matched pairs and DEXA scans were used to ensure similar bone quality. Group I (6 specimens) consisted of specimens stabilized with a superior precontoured distal clavicle locking plate, screws and supplemental coracoclavicular fixation using a suture anchor device. Group II (6 matched contralateral specimens) was the same construct without coracoclavicular fixation. Each specimen was cyclically loaded in the coronal plane at 40 to 80 N for 17,500 cycles (equivalent to cyclic loading on the protected shoulder in ambulating patient for 1 week). Load to failure testing up to 1000N was then performed on the specimens that did not fail cyclical loading. Outcome measures included the mode of failure and either the number of cycles or maximum load required to create 10 mm of displacement in the construct. Results: All specimens (12/12) completed the cyclic testing without failure and underwent load to failure testing. Group 1 specimens with CC fixation failed at a mean of 817 N (range, 675-980 N), whereas group 2 specimens without CC fixation failed at a mean of 438 N (range, 300-640 N) (p¼0.005). All but two specimens in group 1 (4/6) failed by anchor pull out from the coracoid. One specimen did not fail at the maximal load the materials testing machine was capable of exerting (1000 N). One specimen failed by distal clavicle fracture fragment fragmentation. No coracoid
ASES Abstracts
e37
fractures occurred. Group II specimens failed by distal clavicle fracture fragment fragmentation (3) and acromioclavicular (AC) joint displacement of greater than ten millimeters (1). Two group II specimens did not fail at the maximal load of the materials testing machine. Conclusion: CC fixation is a useful adjunct to augment plate fixation in type IIB distal clavicle fractures.
32 ADAPTING TO A NEW ERA OF PATIENT SATISFACTION DRIVEN REIMBURSEMENT: SETTING PATIENTS’ EXPECTATIONS FOR RANGE OF MOTION AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR Joshua D. Harris, MD, Amy L. Ravindra, MD, Grant L. Jones, MD, R. Bryan Butler, MD, Julie Y. Bishop, MD, The Ohio State University Medical Center, the Ohio State University College of Medicine, and the Ohio State University Sports Medicine Center, Columbus, Ohio, USA Objectives: The primary goal of this study is to determine if there is a difference in pre- and postoperative ROM between small, medium, and large isolated rotator cuff tears treated with arthroscopic rotator cuff repair. Secondarily, we wanted to determine if early stiffness resolves, and at what time point postoperatively motion is restored. We hope that this information can be used to advise and reassure patients on what is normal, and to promote realistic patient expectations at frequent time points postoperatively. Methods: A retrospective case series of patients treated with arthroscopic rotator cuff repair is reported. Two shoulder fellowship-trained surgeons performed 804 repairs between September 2006 and July 2010. All repairs with concomitant procedures (other than subacromial decompression, biceps tenotomy, or debridement) were excluded. Three groups were analyzed: 1) Small tears (defined as a partial or full-thickness tear less than one centimeter in size); 2) Medium tears (defined as full-thickness tears between one and three centimeters in size); and 3) Large tears (defined as full-thickness tears greater than three centimeters in size). After application of exclusion criteria, there were 274 patients analyzed for this study with up to one year follow-up. Active and passive range-of-motion for both groups was collected pre- and post-operatively at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months. Continuous data was reported as mean +/- standard deviation. Groups of data were compared using a two-tailed student’s t-test assuming a normal distribution. Results: At all points pre-op and post-op large tears were significantly stiffer than the small tears (p < 0.0055 for all time points) in external rotation (ER). The large tears were also significantly stiffer in ER than the medium tears at preoperatively and at 3, 6, and 12 months (p < 0.05). Small, medium, and large tears do not regain full (preoperative) ER ROM until 1 year postoperative. For ROM in forward elevation, large tears were significantly stiffer than small tears for all points from 6 weeks through 1 year postoperatively (p < 0.05). Full (preoperative) motion in FE is restored at 3 months for small tears and at 6 month for medium and large tears. Conclusions: Significant differences in shoulder motion were observed following arthroscopic repair of small, medium, and large isolated rotator cuff tears. Large tears are stiffer than small at all time points in external rotation. It takes one year to restore external rotation for small and medium tears, and large tears have residual stiffness in ER at one year. Full forward elevation is restored earlier (3 months for small and 6 months for medium and large tears).