Patients with multidirectional glenohumeral instability without a Bankart lesion represent a challenging group. Arthroscopic pancapsular plication affords the surgeon flexibility to correct the degree and direction of laxity in the multidirectionally unstable patient. This technique can be combined with suture anchors if needed to correct capsulolabral defects in patients with more advanced lesions. The mainstay of treatment for MDI remains conservative. In resistant cases, however, arthroscopic management can be performed safely and efficaciously, now with documented extended success in an active patient population.