Arthroscopic Labral-Sparing Technique for Shoulder Capsulorrhaphy in Multidirectional Instability Patients

Multidirectional instability (MDI) of the shoulder can be a difficult clinical entity to both diagnose and treat. When surgical stabilization is indicated, the treatment of choice is capsulorrhaphy with capsular shift, and this can be performed by either open or arthroscopic procedures. With the continued advancement of arthroscopic techniques and instrumentation, a growing number of these patients are being treated arthroscopically with positive results. A unique anatomic characteristic that can be seen in the MDI patient is a diminutive or hypoplastic labrum that is devoid of a labral tear. This characteristic is important to recognize because it has implications in the surgical techniques used when stabilizing the MDI shoulder arthroscopically. It may be technically difficult-and even iatrogenically damaging-to attempt to incorporate the labrum in these cases in which minimal to no labral tissue is present. Therefore, the purpose of this article is to provide instruction for an arthroscopic labral-sparing technique for shoulder capsulorrhaphy in the MDI patient.