This video discusses the case presentation of a 36-year-old woman with left lateral ankle pain and mechanical symptoms caused by a large osteochondral lesion of the talus. Previous treatment included open osteochondral autografting, which was performed 10 years ago at an outside facility. Informed consent was obtained, and the patient elected to proceed with fresh allograft transplantation. A fresh allograft matching the patient’s native talus was obtained using imaging-based measurements.

Intraoperatively, ankle distraction aided in obtaining adequate visualization of the talar lesion and facilitated appropriate sagittal and axial saw cuts. The cut portion of talus was used as a template for cuts on the fresh allograft for transplantation. Appropriate allograft fit was ensured via biplanar fluoroscopy, and the allograft was secured via screw fixation.

Postoperatively, the patient's leg was placed in a short leg splint. The patient was eventually transitioned to a controlled ankle motion boot to facilitate early tibiotalar range of motion. The patient was kept non-weight bearing for 3 months postoperatively.