We have evaluated the results after rehabilitation and compared this to inferior capsular shift in patients with multidirectional hyperlaxity (MDH). The patients (n=35) experienced either instability and/or pain. We divided the patients into two groups: one group (group A) included patients with MDH and only pain but no symptoms of instability (n=6). All these patients had initial rehabilitation, followed by surgery in four cases. None of the patients with only pain (n=6) were satisfied after rehabilitation. Only two out of four were satisfied after surgery. In the second group (group B) were included patients who had MDH with both pain and instability. Six patients had surgery without prior rehabilitation and 20 patients had initial rehabilitation. Eight of these patients had surgical stabilization after unsuccessful rehabilitation. Less than half of the patients with MDH and instability (n=20) were satisfied after rehabilitation alone. Twelve of 14 patients were satisfied after surgery. We conclude that patients with MDH and only pain are difficult to treat. Patients with MDH and instability respond only moderately to the exercise program. Surgery, in combination with physiotherapy, should be the initial treatment when instability is the main symptom.