Osteochondral lesions of the talus, large or small, are challenging for the treating orthopaedic surgeon. These cartilage and bony defects can cause substantial pain and functional disability. Surgical treatment of small osteochondral lesions of the talus has been thoroughly explored and includes retrograde drilling, arthroscopic débridement and marrow stimulation, osteochondral autografting from cartilage/bone unit harvested from the ipsilateral knee (mosaicplasty), and autologous chondrocyte implantation. Although each of these reparative, replacement, or regenerative techniques has varying degrees of success, they may be insufficient for the treatment of large osteochondral lesions of the talus. Large-volume osteochondral lesions of the talus (>1.5 cm in diameter or >150 mm(2) in area) often involve a sizable portion of the weight-bearing section of the talar dome, medially or laterally. A fresh structural osteochondral allograft is a viable treatment option for large osteochondral lesions of the talus.