Several anatomical features contribute to posterior shoulder instability. Isolated soft tissue procedures in the presence of a significant glenoid bony pathology can result in high recurrence rates. The recognition of glenoid bone loss is essential for the success of the chosen treatment. The primary objective is to generate a safety profile for posterior anatomic glenoid reconstruction. The secondary objective is to evaluate the clinical trends and radiological outcomes of patients who underwent this procedure. To our knowledge, there are no clinical papers on this topic to this date. This study is a retrospective review of medical charts and diagnostic images of subjects who had posterior shoulder instability with glenoid bone loss and underwent posterior anatomic glenoid reconstruction by one surgeon (IW). Data was collected from pre and post-operative evaluations. This included an assessment by the Western Ontario Shoulder Instability (WOSI) index, as well as the pre-operative and post-operative imaging. This cohort of patients consisted of nine subjects with a mean age of 33.26 ± 9.94 years at a minimum follow-up of two years. There were no intra-operative or post-operative complications. All subjects had a stable shoulder at the latest follow-up. The overall mean pre-operative and post-operative WOSI scores (± SD) at the most recent follow-up were 72.60 ± 14.98 and 18.86 ± 16.77, respectively (p<0.05). The average AP dimension of the glenoid with graft at the most recent CT follow-up was 29.78 ± 3.49 mm. All patients demonstrated graft healing, and the grafts were shown to be placed in an excellent position. Of the nine patients, two did not demonstrate resorption, six demonstrated grade 1 resorption, and one demonstrated grade 2 resorption. The average screw alpha angle was 15.8 ± 4.6. Arthroscopic posterior shoulder stabilization with distal tibia allograft reconstruction demonstrates promising clinical, functional and radiographic results with an excellent safety profile. However, further investigations are required to obtain the longevity of the positive outcomes.