Advances in shoulder arthroscopy and improved understanding of the pathoanatomy following shoulder instability have led to increased recognition of combined lesions of the glenoid labrum. Although the diagnosis of combined labral tears is often made with physical examination and magnetic resonance imaging, combined tears can be discovered intraoperatively. A high index of suspicion is necessary, especially in the setting of chronic recurrent shoulder instability or previous failed labral repair. Over a 6-year period at a military institution, combined labral repairs comprised 37% of all patients undergoing any labral repair. With accurate identification of all labral pathology and a systematic approach to labral repair, successful outcomes can be achieved.