Multidirectional Instability (MDI) Treatment

Overview

Multidirectional instability (MDI) is symptomatic shoulder instability in two or more directions, typically atraumatic, often bilateral, and linked to generalized ligamentous laxity. Most patients improve with a structured strengthening program, and surgery is reserved for those who don't. Arthroscopic capsular plication, when needed, tightens the redundant shoulder capsule to reduce excess motion.

How Dr. Raffo Performs This Procedure

Arthroscopic capsular plication is performed through shoulder arthroscopy portals:

1. The shoulder is examined under anesthesia to confirm the direction and degree of instability.
2. Redundant capsular tissue is identified circumferentially, wherever the laxity is greatest.
3. Sutures are placed to fold and tighten the excess capsule, reducing the overall volume of the joint capsule and restoring a more normal degree of restraint.
4. In patients without a labral tear, this is typically a capsule-only procedure; concurrent labral pathology, when present, is addressed at the same time.

Who Is This For?

• Patients, often younger and more flexible, whose shoulders feel loose or unstable in more than one direction without a specific injury.
• Patients with a positive sulcus sign on exam and a Beighton hypermobility score reflecting generalized ligamentous laxity.
• Patients who have completed a real course of physical therapy directed specifically at shoulder stability and remain symptomatic.
• It is not the right page for a shoulder that dislocated once, in one direction, after a clear traumatic event — that pattern points to the anterior or posterior instability pages instead.

Recovery & Rehabilitation

• 0–4 to 6 weeks: Sling immobilization; passive range of motion only, as directed, to protect the plicated capsule.
• 6–12 weeks: Progressive active motion and early strengthening.
• 3–5 months: Sport-specific and functional strengthening.
• 5–7+ months: Return to sport; in the largest capsular plication series, 45 of 50 patients returned to their same level of sport, and all 50 returned to work (Witney-Lagen, JSES 2017).