Arthroscopic plication for multidirectional instability: 50 patients with a minimum of 2 years of follow-up

Treatment of patients who have not improved after physiotherapy for multidirectional instability (MDI) remains challenging, with no agreed best practice. The purpose of this study was to ascertain whether arthroscopic plication is safe and effective for these patients.

Fifty consecutive patients who had not improved after at least 6 months of specialized shoulder physiotherapy for symptomatic MDI and no labral lesion at arthroscopy underwent arthroscopic plication between 2006 and 2013. Outcome measures were preoperative and postoperative Oxford Instability Scores (OIS), recurrence of instability, return to work and sport, surgical complications, and patient satisfaction.

The study comprised 32 male and 18 female patients, with a mean age of 26 years (range, 16-46 years). Complete OISs were available in 43 of 50 patients, and 41 patients had good or excellent postoperative OIS. The mean OIS was 16.2 preoperatively compared with 42.5 postoperatively (P < .001). There was no difference in OIS improvement between male and female patients (P = .962) or in those aged younger than 25 years vs. older than 25 years (P = .789). Patients with Beighton scores of 4 to 9 showed smaller OIS improvement (P = .030) and were less likely to achieve excellent postoperative OISs (P = .010). There were 2 patients with recurrent instability. All patients successfully returned to work, and 45 of 50 patients returned to the same level of sport. Surgical complications were shoulder stiffness in 1 patient that resolved with physiotherapy and 1 superficial wound infection that was successfully treated with flucloxacillin. Forty-seven of 50 patients were satisfied.

Arthroscopic plication is a safe and effective treatment for MDI in patients without labral lesions who have not improved after 6 months of specialized shoulder physiotherapy.