Environmental impact of open versus arthroscopic coracoid bone-block procedures

Purpose : The current global warming context requires finding less polluting alternatives in clinical practice. For anterior glenohumeral instability with a high recurrence risk, coracoid bone-block stabilization can be performed either openly or arthroscopically, with no differences in clinical outcomes between the two techniques. Given that both methods yield excellent and comparable patient results, this study aimed to compare their environmental impacts. The hypothesis was that arthroscopic procedures have a higher environmental impact than open procedures. Methods : This prospective, comparative, non-randomized, multicenter (two centers) study was conducted in France from May to September 2024. Two groups (open versus arthroscopic bone-block procedures) were compared, with four consecutive procedures in each group. For each operation, collected data included the consumables used, volume of sterile saline solution, operating room occupancy time, duration of general anesthesia, and total waste weight. Using these data, total CO₂ emissions (kg CO₂eq) and emissions per studied parameter were estimated using eco-design software. Results : Arthroscopic procedures emitted an average of 12.3 kg CO₂eq more than open procedures (p<0.05). Arthroscopic surgery also consumed twice as much electricity (42.3 kWh vs. 20.1 kWh; p<0.05), required 19 times more sterile saline solution (19.25L vs. 1L; p<0.05), and generated 4.5 times more waste (15.15 kg vs. 3.38 kg; p<0.05). Conclusion : Arthroscopic coracoid bone-block procedures have a significantly greater environmental impact compared to open procedures. Additional CO₂ production should be considered when choosing a surgical technique. Trial registration number : 25-076, registered on march 24 ^th of 2025 Level of evidence : Prospective comparative study, Level III.