The ALTO Nano offers a downsized platform head for exact placement on the TM despite surrounding bone. The small size of the Nano reduces the chance of extrusion around the cartilage graft. The ALTO Nano is available in the centered or offset design as either a total or partial prosthesis. An option of an integrated footplate shoe is available on the offset total prosthesis. The ALTO Nano is packaged with disposable sizers and preloaded in the patented ALTO adjuster which simplifies the need to properly size the implant.