Osteochondral lesions of the talus (OCLT) are a challenging entity despite the advancements that have been made to treat focal deficits of articular cartilage. Both autograft and allograft reconstruction have had documented success in the treatment of OLCT. Universal availability and known chondrocyte viability makes the osteochondral autograft transfer system (OATS) an excellent option for recurrent, deep, or moderate defects. For defects with a large diameter, large cystic component, or heavily involving the shoulder of the talus, an allograft provides an excellent option. This article focuses on the efficacy and determination of the most appropriate graft reconstruction: allograft reconstruction or OATS.