Recurrent posterior shoulder instability is an uncommon, debilitating condition in young adults that is being diagnosed with increasing frequency. Although a number of predisposing factors have been identified, their relative importance remains poorly understood. Poor results have been reported following operative intervention to treat recurrent posterior instability with nonanatomic techniques. The more recent development of lesion-specific surgery has improved clinical results, particularly when that surgery has been performed arthroscopically. Operative treatment is therefore being increasingly recommended at an earlier stage to patients who do not respond to supervised rehabilitation programs.