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.