title: Open Latarjet versus arthroscopic Latarjet: clinical results and cost analysis.
abstract: OBJECTIVE
  The aim of this study was to compare the clinical results between open and arthroscopic Latarjet and perform a cost analysis of the two techniques.
  
  
  METHODS
  A systematic review of articles present in PubMed and MEDLINE was performed in accordance with PRISMA guidelines. Studies concerning post-operative outcomes following Latarjet procedures for chronic anterior shoulder instability were selected for analysis. The clinical and radiographic results as well as the costs of the open and arthroscopic techniques were evaluated.
  
  
  RESULTS
  Twenty-three articles, describing a total of 1317 shoulders, met the inclusion criteria: 17 studies were related to open Latarjet, and 6 to the arthroscopic technique. Despite the heterogeneity of the evaluation scales, the clinical results seemed very satisfactory for both techniques. We detected a statistically significant difference in the percentage of bone graft healing in favour of the open technique (88.6 vs 77.6 %). Recurrent dislocation was more frequent following open surgery (3.3 % after open surgery vs 0.3 % after arthroscopy), but this finding was biased by the large difference in follow-up duration between the two techniques. The direct costs of the arthroscopic procedure were double in comparison to open surgery (€2335 vs €1040). A lack of data prevented evaluation of indirect costs and, therefore, a cost-effectiveness analysis.
  
  
  CONCLUSIONS
  The open and arthroscopic Latarjet techniques showed excellent and comparable clinical results. However, the much higher direct costs of the arthroscopic procedure do not seem, at present, to be justified by a benefit to the patient.
  
  
  METHODS
  III.
authors.affiliation: 2nd Orthopaedic Department, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy. pietro.randelli@unimi.it.|Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy. pietro.randelli@unimi.it.
authors.forename: P
authors.initials: P
authors.lastname: Randelli
authors.affiliation: 2nd Orthopaedic Department, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.|Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Fossati
authors.affiliation: 2nd Orthopaedic Department, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.|Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Stoppani
authors.affiliation: Orthopaedic Clinic of University of Catania, Via Plebiscito no 628, Catania, Italy.|Department of Surgery, University of Catania, Via Santa Sofia no 78, 95100, Catania, Italy.
authors.forename: F R
authors.initials: FR
authors.lastname: Evola
authors.affiliation: Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: De Girolamo
mesh_terms: D001182:Arthroscopy / Q000191:economics* / Q000379:methods*; D016025:Bone Transplantation / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012540:Scapula / Q000601:surgery*; D012783:Shoulder Dislocation / Q000209:etiology; D012785:Shoulder Joint / Q000601:surgery*
keywords: Arthroscopic Latarjet procedure; Coracoid bone block; Cost-effectiveness analysis; Open Latarjet procedure; Shoulder instability