Treatment of Failed Arthroscopic Multidirectional Instability Repair: Next Options?

Multidirectional instability (MDI) of the shoulder presents a unique challenge in orthopedics due to its complex etiology and varied patient profiles. MDI can arise from congenital ligamentous laxity, atraumatic repetitive microtrauma, or traumatic events. The pathophysiology involves an imbalance between shoulder mobility and stability, with significant contributions from both static and dynamic stabilizers. Initial management focuses on conservative treatments, emphasizing physical therapy to strengthen the dynamic stabilizers of the glenohumeral joint. Surgical options, primarily open inferior capsular shift and arthroscopic capsular plication, have shown comparable success rates. However, revision surgery outcomes remain poorly defined, with limited literature indicating low success rates and a need for tailored approaches based on individual pathology. This chapter outlines the treatment of failed MDI surgeries and optimized return-to-sport outcomes for affected individuals.