Soft tissue interposition with hemiarthroplasty recently has generated considerable interest as a treatment alternative in the younger patient with advanced arthritis of the glenohumeral joint. Despite early promising results, there have been concerns regarding the durability of currently used interposition materials in the shoulder. The authors hypothesized that resurfacing the glenoid with a lateral meniscal allograft would offer several advantages to the previously described techniques. These advantages include an established history of synovial healing in the knee, improved structural characteristics for durability, and a wedge shape that could compensate for pre-existing glenoid wear. A technique was developed to allow secure fixation of the meniscal allograft to the glenoid in combination with hemiarthroplasty replacement of the humeral head. The authors discuss the indications and contraindications for the procedure and describe the surgical technique.