Most osteochondral lesions of the talus (OLTs) may be managed successfully with arthroscopic debridement in combination with either microfracture or drilling. However, treatment with debridement and microfracture/drilling tends to be less reliable in large OLTs, OLTs associated with loss of the talar shoulder architecture, and OLTs associated with large subchondral cysts. When the talar shoulder is compromised due to a large OLT, then a structural graft may be considered to reconstruct the deficient portion of the talar dome. In this situation, fresh and fresh-frozen allograft tali have been used. Although reports of structural allograft reconstruction for the talar dome are sparse, the limited literature on this subject suggests that successful outcome is feasible. This article focuses on our experience with structural allograft reconstruction for large OLTs. Copyright © 2011 by Lippincott Williams & Wilkins.