The purpose of this study was to assess patient outcome after a selective capsular repair approach for treatment of both anterior and multidirectional instability. Seventy patients with diagnoses of shoulder instability, 38 anterior and 32 multidirectional, were retrospectively evaluated at an average of 3.1 years (range, 2–6 years). All 70 underwent repair through an anterior approach. The mean age of the 45 male and 25 female patients was 26.3 years (range, 15–79 years) at the time of surgery. Half of the 70 patients had diagnoses of atraumatic/microtraumatic recurrent instability. A rotator interval defect was noted and closed in 44% of the patients. All patients were noted to have capsular redundancy at the time of surgery. Results of this study demonstrate improved patient function and return to sport compared with previously reported studies of treatment of shoulder instability. After surgery, three patients had recurrent instability. No patient had a restriction of motion more than 10° of external rotation compared with the contralateral arm. Ninety-four percent of the patients had increased function of their shoulder in the overhead position. The authors conclude that the care of patients with anterior or multidirectional instability can be achieved by using a selective capsular tightening approach based on each patient's specific pathologic condition. This capsular repair corrects instability of the glenohumeral joint, maintains symmetric range of motion, and allows the patient to return to overhead shoulder activity.