Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 2, pp 630–639 | Cite as

Effects of surgical management on multidirectional instability of the shoulder: a meta-analysis

  • Dong Chen
  • Jerome Goldberg
  • Jonathan Herald
  • Ian Critchley
  • Arshad Barmare



The purpose of this study was to assess the effectiveness of arthroscopic and open surgical techniques on the treatment of shoulder multidirectional instability.


Literature searches were conducted using the databases MEDLINE, Embase,, the Cochrane Library, and the Cochrane Central Register of Controlled Trials. Original articles on the surgical management of multidirectional instability were retrieved against selection criteria. Data were extracted and divided into three groups by surgical technique. Proportion and mean meta-analyses were performed for comparison.


The available evidence was from 35 level IV and 1 level II studies. The recurrent instability rate was 9.9 % (95 % CI 7.3–12.9 %) in open capsular shift (OCS) group and 6.0 % (95 % CI 3.7–8.9 %) in arthroscopic capsular plication (ACP) group, between which no difference was observed. However, thermal capsular shrinkage (TCS) group resulted in a recurrent instability rate of 23.9 % (95 % CI 16.6–32.2 %), significantly higher than the above two groups. OCS and ACP groups revealed low reoperation rates of approximately 5.2 % (95 % CI 2.7–8.5 %) and 4.8 % (95 % CI 2.3–8.0 %), respectively, which are lower than that in TCS group of 16.9 % (95 % CI 12.4–21.8 %). OCS caused more loss of external rotation than ACP, losing 7.0 (95 % CI 3.3–10.6) degrees versus 2 (95 % CI 0.9–2.4) degrees, respectively.


ACP and OCS techniques have similar primary outcomes, but the former causes less post-operative stiffness. It is suggestible to avoid TCS in the treatment of MDI.

Level of evidence

Level IV.


Shoulder Multidirectional instability Arthroscopic capsular plication Open inferior capsular shift Electrothermal arthroscopic capsulorrhaphy Recurrent instability 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

This study was a meta-analysis study and did not involve human or animal studies.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Dong Chen
    • 1
  • Jerome Goldberg
    • 2
  • Jonathan Herald
    • 3
  • Ian Critchley
    • 1
  • Arshad Barmare
    • 1
  1. 1.Orthopaedic Department, Goulburn Valley HealthThe University of MelbourneSheppartonAustralia
  2. 2.Prince of Wales HospitalUniversity of New South WalesSydneyAustralia
  3. 3.Orthopaedic Department, Bankstown HospitalUniversity of Western SydneySydneyAustralia

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