Treatment of osteochondral lesions of the talus proves to be challenging given the unique anatomy of the intra-articular surface and associated complexity of larger lesions. Simple bone marrow stimulating procedures for large complex lesions often lead to poor results with increased risk of lesion progression, refractory pain and associated functional limitations. Other methods of osteochondral auto or allografts often require osteotomies, bone windows or fibrin glue which are associated with donor pain and nonunion. Thus, for larger and cystic lesions, we report our experience using a modified low-flow arthroscopic sandwich technique consisting of autologous cancellous bone graft, followed by a viable cryopreserved cartilage fiber, cartilage allograft matrix putty.