Cost-effectiveness analysis of Latarjet versus arthroscopic Bankart with remplissage in anterior shoulder instability: A retrospective cohort study from Ecuador

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Abstract

Background Recurrent anterior shoulder instability with subcritical glenoid bone loss poses a treatment dilemma. Arthroscopic Bankart repair with additional remplissage and the open Latarjet procedure are commonly used, but their real-world economic impact in Latin America is poorly defined. Objective To compare midterm clinical outcomes and real-world costs between the Latarjet procedure and arthroscopic Bankart repair with additional remplissage in Ecuadorian patients with subcritical glenoid bone loss, representing a surgical decision “gray zone” rather than prognostically equivalent populations. Methods A retrospective cohort of 40 patients (20 per group) with ≥48 months of follow-up was analyzed. Functional outcomes (Constant, Rowe, SANE) and direct and indirect costs were assessed and standardized to 2022 USD. Results Functional outcomes were comparable, with no recurrent dislocations observed. Total costs were significantly lower for the Latarjet procedure (USD 4625 vs. USD 10,092), mainly due to implant-related expenses. Conclusion When clinical outcomes are comparable, the Latarjet procedure was associated with lower overall costs, supporting a value-based surgical approach tailored to local healthcare settings. Level of Evidence IV – Retrospective Comparative Study.