Fig. (5) The fresh osteochondral allograft transplantation technique is demonstrated. Medial malleolus osteotomy is performed to access the large lesion on the mid-medial of the talus (5A, MM = medial malleolus). The lesion was measured by cannulated allograft OATS sizers and the K-wire was inserted on the center of the lesion (5B) and the counterbore is then drilled to the lesion and subchondral bone to a depth of 6- to 8-mm (5C). The sizer is used to measure the depth (5D) and the donor fresh talar allograft was secured in the allograft OATS workstation (5E). The talar allograft is implanted into the recipient talar bed until all edges are flush with the surrounding cartilage rim (5F).