This case series reports two-year results of an arthroscopic transglenoid multiple-suture capsular shift for multidirectional shoulder instability. Nineteen consecutive shoulders were treated after failing a rotator cuff and scapular stabilizer strengthening program. Outcomes were graded with the Tibone-Bradley Athletic Shoulder Outcome scale at a mean 34-month follow-up.
When you see a young athlete with atypical shoulder pain and a positive sulcus sign, think MDI and start with a rotator cuff and scapular stabilizer program before considering surgery. The sulcus sign reflecting inferior capsular laxity is the hallmark of MDI, and this series reinforces why every capsular shift, open or arthroscopic, aims to reduce capsular volume and eliminate redundancy.
This is early Level IV evidence: 19 patients, retrospective data collection, no control group, and no standardized MDI definition. Read the 91/100 average score in that context rather than as proof of superiority over open shift.
The practical pearls are in the subgroups. Voluntary or positional instability and younger age (under 20) trend toward worse results, and the authors suggest a voluntary subluxator may be better served by an initial open shift. Workers' Compensation status also predicted inferior outcomes, a recurring theme across shoulder instability literature worth remembering when you counsel these patients.
This case series reports two-year results of an arthroscopic transglenoid multiple-suture capsular shift for multidirectional shoulder instability. Nineteen consecutive shoulders were treated after failing a rotator cuff and scapular stabilizer strengthening program. Outcomes were graded with the Tibone-Bradley Athletic Shoulder Outcome scale at a mean 34-month follow-up.
When you see a young athlete with atypical shoulder pain and a positive sulcus sign, think MDI and start with a rotator cuff and scapular stabilizer program before considering surgery. The sulcus sign reflecting inferior capsular laxity is the hallmark of MDI, and this series reinforces why every capsular shift, open or arthroscopic, aims to reduce capsular volume and eliminate redundancy.
This is early Level IV evidence: 19 patients, retrospective data collection, no control group, and no standardized MDI definition. Read the 91/100 average score in that context rather than as proof of superiority over open shift.
The practical pearls are in the subgroups. Voluntary or positional instability and younger age (under 20) trend toward worse results, and the authors suggest a voluntary subluxator may be better served by an initial open shift. Workers' Compensation status also predicted inferior outcomes, a recurring theme across shoulder instability literature worth remembering when you counsel these patients.