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Posterior glenohumeral instability is an uncommon entity that presents a challenging clinical problem. As compared with anterior glenoid bone loss and instability, the treatment of posterior glenoid deficiency with extra-articular bone graft has had mixed results. We present the surgical technique and successful long-term follow-up for the use of distal tibial osteochondral allograft for the treatment of posterior glenoid deficiency in a young male athlete after 2 failed soft tissue repairs. Our case and a review of the early results in the literature demonstrate that distal tibial allograft seems to be an effective bone graft option for posterior glenoid reconstruction in the setting of recurrent posterior glenohumeral instability. Further studies involving more subjects with long-term results are needed to guide future surgical indications.