The treatment of recurrent glenohumeral instability, especially with a concomitant bony lesion, remains challenging. Moreover, the presence of an engaging reverse Hill-Sachs in combination with posterior instability will result in the need for a more aggressive treatment option. Large bony defects of the humeral head have traditionally been treated with a fresh humeral head allograft. However, these are difficult to obtain (can take >6 months to obtain from graft donor companies), and have to be size matched. We have found in our lab that the talus fits the humeral head well and near anatomic. The superior articular surface of the talus may be used to reconstruct the articular surface of the humeral head. This is my preferred primary technique for treatment of an engaging reverse Hill-Sachs lesion with recurrent glenohumeral instability through use of a fresh osteochondral talus allograft that is fixed with headless titanium compression screws.