Arthroscopic Latarjet using Double Suture-Button Fixation: Learning Curve, Graft Positioning, and Complications – A Two-Center Study of 80 Patients

Background The guided arthroscopic Latarjet procedure with double suture-button fixation has emerged as an alternative to traditional open or arthroscopic screw fixation technique for treating anterior shoulder instability in patients at high risk of recurrence. Purpose To analyze the learning curve (LC), clinical outcomes, computed tomography (CT) findings, and complications associated with this technique by evaluating the first 80 consecutive cases performed at two institutions. Methods This retrospective cohort study analyzed prospectively collected data from 80 patients (mean age 27.3 ± 7.7 years) who underwent this technique for traumatic anterior shoulder instability between 2017 and 2024. Patients were divided into two groups (Group A: first 40 cases; Group B: subsequent 40 cases) based on cumulative sum (CUSUM) analysis of operative time. The learning curve was assessed by comparing operative time and complication rates between groups. Clinical evaluation included Subjective Shoulder Value (SSV) and Rowe scores. CT scans were used to assess graft positioning and healing. Minimum clinical follow-up was 6 months (mean 27 ± 20 months). Results Operative time decreased significantly from 167 minutes in the first 40 cases to 110 minutes in the most recent 40 cases (p<0.001). At final follow-up, mean SSV was 91.2% and mean Rowe score was 94 points. Optimal graft positioning was achieved in most cases in the sagittal and axial planes (subequatorial: 87.5%; flush: 92%). Graft rotation was observed in 29% of cases during the learning curve. Radiographic graft healing within the first 6 months was 68%. The main intraoperative problem was conversion to open procedure (5%), all in Group A. The rate of adverse events (problems and complications) decreased from 20% in the early cohort to 12.5% in the late cohort. Reoperation and redislocation rates were 3.7% and 2.5%, respectively. No hardware-related complications were observed. Conclusion The arthroscopic Latarjet using double suture-button fixation provides satisfactory short- to medium-term clinical outcomes and reliable graft positioning, with operative time decreasing significantly after 20 cases. Although graft rotation and delayed healing may be observed in some cases, they do not appear to affect clinical outcomes. The guided nature of this technique and the use of a low-profile endobutton device reduce the adverse events rate (problems and complications) and eliminate hardware-related morbidity and reoperations. Based on these findings, surgeons with adequate arthroscopic experience who are considering adopting the arthroscopic Latarjet may regard this technique as an accurate, reproducible, and reliable alternative to traditional screw fixation.