title: Comparison of arthroscopic and open Latarjet with a learning curve analysis.
abstract: OBJECTIVE
  To compare arthroscopic and open Latarjet performed by a single shoulder surgeon with learning curve analysis
  
  
  METHODS
  A comparative and learning curve analysis was carried out on a prospectively gathered database of 2 consecutive series of patients treated with arthroscopic and open Latarjet procedures performed by a single shoulder surgeon between 2008 and 2014. The database included patient characteristics, ISIS scores, operative time, intra- and postoperative complications, graft and screws positioning, as well as pre- and postoperative Walch-Duplay scores.
  
  
  RESULTS
  Sixty-four patients were included in the study, 28 in the arthroscopic group and 36 in the open group with similar age, sex ratio and preoperative ISIS score. Operative time was significantly higher in the arthroscopic group (146 versus 81 min, p = 0.001), and although no intra-operative complications were recorded in either group, there were significantly more postoperative complications in the arthroscopic group (29 vs. 11 %, p = 0.03). Screw placement was more accurate in the open group, and postoperative Walch-Duplay score did not show any significant difference between the groups (88 points in the arthroscopic group and 91 points in the open group). The arthroscopic Latarjet learning curve analysis showed that the need for conversion ceased after the first 10 patients and that surgical time came close to that of open procedure after 20 procedures.
  
  
  CONCLUSIONS
  In this study, 10 arthroscopic Latarjet procedures were needed to overcome the need for conversion, and 20 procedures to achieve equal operating time to the open technique. Even though functional outcome and patient satisfaction were similar in both techniques, complications, screw placement inaccuracy, persistent apprehension and recurrences still remain higher with the arthroscopic technique.
  
  
  METHODS
  Retrospective comparative analysis, Level III.
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. gregory.cunningham@hcuge.ch.
authors.forename: G
authors.initials: G
authors.lastname: Cunningham
authors.affiliation: Clinique romande de réadaptation, Av. Grand Champsec 90, 1951, Sion, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Benchouk
authors.affiliation: Department of Internal Medicine, La Tour Hospital, Rue J.-D. Maillard 3, 1217, Meyrin, Switzerland.|Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Kherad
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. alexandre.laedermann@gmail.com.|Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland. alexandre.laedermann@gmail.com.|Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, 1217, Meyrin, Switzerland. alexandre.laedermann@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Lädermann
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012008:Recurrence; D012189:Retrospective Studies; D012540:Scapula / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*
keywords: Arthroscopic and open Latarjet; Complication; Instability; Learning curve; Shoulder surgery