The most important findings of our study were that the differences in clinical and functional outcomes were not statistically significant in both the groups. The cosmetic satisfaction was 100% in the Bankart group, whereas it was only 80% in the Latarjet group. Three recurrence occurred in the Bankart group, while 2 superficial infections occurred only in the Latarjet group. The arthroscopic Bankart repair was more costly than the open Latarjet procedure.
The Latarjet procedure for recurrent shoulder dislocation has been an established method for treating recurrent shoulder dislocation . However, trends towards minimally invasive procedures have led the surgeons around the world to choose for the arthroscopic Bankart repair [7, 12, 29]. Thomazeau et al.  conducted a survey to find whether the shoulder surgeons preferred the Latarjet or arthroscopic Bankart repair. They found that irrespective of the status of the patients and glenoid bone loss, 72% of French shoulder surgeons would choose Latarjet procedure, while 90% of the shoulder surgeons from other countries would choose arthroscopic Bankart repair . Some studies reported that the Bankart repair is more anatomic and would provide better shoulder ROM, stability, and minimal recurrence [12, 30–32]. In contrast, other reports suggested that the Latarjet procedure is superior to the Bankart repair, as it provides the triple-stabilizing effect, including anterior glenoid augmentation, capsular repair and sling effect, that significantly reduces the recurrence rate and a better return to preinjury status, especially in young and active individuals [12, 14, 18, 33]. It is even effective in significant glenoid bone loss and revision for failed stabilization procedure .
An et al.  in their systematic review and meta-analysis concluded that the Latarjet procedure to be superior to the Bankart repair, offering better patient-reported outcomes, no restriction of external rotation, and provides more excellent stability without increasing complication. Our result showed that the open Latarjet procedure to produce better patient-reported outcomes compared to the arthroscopic Bankart procedure, and the external rotation was also not reduced in the Latarjet group. Our results add to the literature that the Latarjet procedure is a viable option with satisfactory clinical and functional outcomes [12, 33, 18, 17, 6].
Patient-reported outcomes, following surgical stabilization procedure, are solely dependent upon the postoperative function, pain, and recurrence [6, 17, 18]. These factors also determine the functional satisfaction. As the surgery for recurrent shoulder dislocation is mainly indicated in young and active individuals, they require not only better function, but also, they have a tremendous aesthetic concern. This is one reason for choosing an arthroscopic Bankart repair by young and high-activity-demanding patients. Our result showed 100% of the patient's cosmetic satisfaction with the Bankart group; however, only 80% of patients were cosmetically satisfied in the Latarjet group. The dissatisfied people in the Latarjet group was mainly the young individuals who really cared about their cosmesis. However, proportion of functional satisfaction was higher (92%) in the Latarjet group than the Bankart group (85%). These results resemble the facts of previous findings that most of the patients are satisfied with the surgery; however, some are not. [6, 17, 18, 33]. Another reason for choosing an arthroscopic procedure is the surgeon's discretion. Because of its fancy nature, surgeons insist on performing arthroscopic Bankart repair even in patients with significant glenoid bone loss or Hill-Sach's lesion.
According to An et al. , overall recurrence was 21% in the Bankart group and 11 % in the Latarjet group. In our study, 3 (7.3%) cases of recurrence occurred in the Bankart group. One redislocation occurred in a 24-year-old man during the gang fight, who had arthroscopic Bankart repair 27 months before. He had redislocation more than 5 times, and finally, he underwent open Latarjet procedure. Another recurrence also occurred in a male patient when he was playing volley-ball, who also underwent a successful Latarjet procedure. The last recurrence occurred in patients who had a sudden onset of seizure disorder for a different medical condition. This patient has not undergone any surgical procedure. No recurrence occurred in the Latarjet group. However, 41 % of the patients in the Bankart group and 25% of the patients in the Latarjet group had a positive apprehension sign. Such patients were not confident enough to go for overhead activities postoperatively. Various reasons could have played for the presence of persistent apprehension, including presence of hyper laxity, high activity level, lack of adequate postoperative rehabilitation, and inadequate fixation technique, etc. These results showed that there might be a possibility of recurrence in the future as the time passes because our follow-up period was only 2 years, or there could be more dislocations if the patients had performed preinjury activities, as most of our patients avoided such activities postoperatively.
Controversy exists regarding the cost-effectiveness of both the surgeries. Min et al.  found that arthroscopic Bankart repair to be more cost-effective as the actual cost of an open Latarjet procedure was $21398 vs. $20,385 for the arthroscopic Bankart group . However, they still mentioned that the recurrence rate of arthroscopic Bankart procedure was higher as compared to the open Latarjet group, and they recommended open Latarjet procedure for a selected group of patients with high demand activities . In contrast, Makhni et al.  found that the arthroscopic Bankart repair is more expensive than the open Latarjet procedure, leading the Latarjet procedure to be more dominant as it was more effective and less costly. The surgical cost in a developing country like Nepal is a huge burden for all people. The government of Nepal has recently implemented a basic medical insurance policy for the public of certain districts of the country . That has made many patients to come to the hospital for definitive treatments for conditions like recurrent dislocation of the shoulder. Unfortunately, many patients do not have such basic medical insurance . Even if they have, the implant costs are not covered. That puts a further burden on the patients. To have their surgery done, patients themselves or family members have to go abroad for earning, or even some have to sell their property [37, 38]. That's why many patients undergo an open Latarjet procedure that is cheaper than the arthroscopic Bankart procedure. In our study, the average cost for the Latarjet was significantly lower than the Bankart procedure, even if we used arthroscopic instruments multiple times that were supposed to be single-use only.
Despite a single experienced orthopaedic surgeon performed all the clinical examinations and not involved in the surgery to avoid the inter-observer bias, various limitations exist in our study. This study has all the biases that a retrospective and non-randomized study has. Despite a comparative study, our sample size was relatively small, and the follow-up period was not longer. Bigger sample size and longer follow-up period would have resulted in differently in terms of recurrence, as many of our patients have a positive apprehension sign and avoided preinjury activities. We prescribed a similar rehabilitation for all the patients; however, many patients did not attend the complete course, which might have directly affected the clinical outcomes of the patients. There might be an institutional bias as this study is from a single government hospital where mostly the economically poor patients come for the treatment.