In comparison with anterior shoulder instability, posterior instability is uncommon, occurring in 2% to 10% of cases, and covering a wide clinical spectrum ranging from locked posterior dislocation to the often subclinical recurrent posterior subluxation (RPS). With increased clinical awareness, imaging advances such as magnetic resonance arthrography, and the development of specific provocative physical examination tests, the identification of RPS in the athletic population is improving. This article describes the anatomic-based arthroscopic approach to treatment of RPS, which allows for enhanced identification and repair of intra-articular pathology including posterior capsular laxity, complete or incomplete detachment of the posterior capsulolabral complex, and inferior capsular tears. While postoperative results are generally good to excellent after stabilization for RPS, there is room for improvement.