Rockwood described a capsulorrhaphy technique for operative treatment of multidirectional shoulder instability with anterior dislocation. We have used this technique mainly in patients with severe multidirectional instability and now have 8 years' experience with it, which is reported below. The surgical technique involves refixation of the Bankart lesion with transosseous suture and double breasting of the anterior capsule. No transposition of the subcapularis muscle was performed. A functional rehabilitation program without immobilization was used in all patients. The daily activity level, the degree of discomfort upon shoulder-related activities and the subjective assessment of outcome were recorded for each patient. General outcome was determined with reference to Rowe's score. A clinical examination was performed as well as radiography. Strength was evaluated by standardized bilateral dynamometry. Follow-up examination was possible in 73 out of 82 patients. The mean age at follow up was 32.7 +/- 4.1 years, and the mean follow-up time, 4.3 years. The reason for surgery was recurrent dislocation in 81% of patients, pain in 4% and both pain and dislocation in 15% of patients. In 8 patients (10.9%) multiple (up to 4) previous surgical attempts by various methods had been unsuccessful. Postoperatively 59% (n = 44) were able to take part in sports without restrictions, 27.4% could take part only in sports not involving the shoulder, and 13.5% (n = 10) did not engage in any sports postoperatively. The redislocation rate was 12.3% (n = 9), and there was 1 traumatic redislocation. A deficit in abduction/elevation by 10-60 degrees was found in 4 patients (5.4%) and by > 60 degrees in 2 patients (2.7%).(ABSTRACT TRUNCATED AT 250 WORDS)