There has been increased recognition of posterior shoulder instability over the last years. Arthroscopic stabilization is the considered gold-standard surgical treatment for symptomatic posterior instability. Its popularity stems from its relative technical simplicity, reliable outcome in patients without significant bony pathology, and the relative complexity of bony surgery performed in the setting of posterior shoulder instability. However, in those with underlying capsular deficiency, glenoid bone loss, excessive glenoid retroversion, or postero-inferior glenoid deficiency, failure rates of posterior stabilization can be much higher. With increasing numbers of surgeries performed for patients with signs of posterior instability, failed posterior stabilizations will be faced more frequently in the practice of a shoulder surgeon. It is therefore essential to understand the reason for failure as well as the treatment options that are available in this revision setting.