Comparison of arthroscopic and open Latarjet with a learning curve analysis

Abstract

Arthroscopic Latarjet is a procedure on the leading edge of modern shoulder surgery. Although many theoretical advantages have been advocated, the learning curve remains arduous, strewn with pitfalls and serious complications. Few authors have published their learning curve, and this is the first study to compare arthroscopic Latarjet to the gold standard open technique. To compare arthroscopic and open Latarjet performed by a single shoulder surgeon and analyze the learning curve. Retrospective comparative analysis. A comparative and learning curve analysis was carried out on a prospectively gathered database of 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 and pre- and postoperative Walch–Duplay scores. Sixty-four patients were included in the study, 28 in the arthroscopic group and 36 in the open group, with a mean age of. Age (26 years, range, 15–45), sex-ratio, preoperative ISIS score were similar in both groups. Operative time was significantly higher in the arthroscopic group (146 versus 81 minutes, P < 0.001), and although no intraoperative complications were recorded in either group, there were more postoperative complications in the arthroscopic group (29% versus 11%, P = 0.03). Screw placement was also more accurate in the open group. Postoperative Walch–Duplay score was similarly high in both groups, but the mean improvement compared to preoperative results was higher in the open group (63 vs 45 points, P < 0.001). Arthroscopic Latarjet learning curve analysis showed that conversion ceased after the first 10 patients and that surgical time dropped and neared that of the open procedure after 20 procedures. Although it takes approximately 10 procedures to overcome most of the arthroscopic Latarjet learning curve, it takes over 20 to achieve an equivalent operating time compared to the open technique. Outcome and patient satisfaction were similar in both techniques. However, complications, screw placement inaccuracy, persistent apprehension and recurrences still remained higher with the arthroscopic technique. Open Latarjet hence remains the gold standard procedure.