Purpose The aim of this study was to compare the accuracy of the coracoid bone graft placement with the open Latarjet-Patte and arthroscopic Latarjet (arthro-Latarjet) procedures in the treatment of anterior instability of the shoulder. Methods Forty-six patients affected by anterior shoulder instability were divided into two groups. In group A ( n = 25), patients were operated by arthroscopic Latarjet (arthro-Latarjet) procedure and in group B ( n = 21), patients were operated by open Latarjet-Patte procedure. Instrumental investigation was based on three-dimensional computed tomography (3D-CT) at a minimum 1-year follow-up. Graft placement and integration, divergence and posterior protrusion of the screws, and glenohumeral osteoarthritis were considered as outcomes. Statistical analysis was performed with chi-square or Fisher's exact test. Significance was set at p < 0.05. Results Positioning of the coracoid graft proved to be optimal in 76% (19/25) of patients of group A and in 100% (21/21) of patients of group B (Fisher's exact test, p = 0.025). Screw placement with respect to the glenoid surface showed a posterior divergence in 44% (11/25) of patients in group A and in 24% (5/21) of patients in group B ( p = 0.15). Posterior protrusion of screw was observed in 76% (19/25) of patients in group A and 71.4% (15/21) of patients in group B ( p = 0.73). Graft integration was present in 76% (19/25) of patients in group A and 85.7% (18/21) of patients in group B (Fisher's exact test, p = 0.48). Mild signs of glenohumeral osteoarthritis were observed in 12% (3/25) of patients in group A and 28.6% (6/21) of patients in group B (Fisher's exact test, p = 0.26). Conclusion Patients operated with open Latarjet-Patte procedure showed better results than those of the arthro-Latarjet group in reference to the positioning of the graft on the coronal plane ( p = 0.025). No significant differences between the groups were observed for graft integration, divergence of the screws, posterior protrusion of the screws, and osteoarthritis. Level of Evidence Level II, nonrandomized prospective comparative study.

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