Osteochondral lesions of the talus are generally the result of trauma and often result in persistent pain and disability. Various treatment options have evolved to treat these challenging problems, ranging from conservative management to marrow stimulation and cartilage or chondrocyte transplantation. Microfracture is the first line of treatment for many of these lesions. However, there is concern that microfracture results in fibrocartilage, which has inferior wear characteristics when compared with native hyaline cartilage. We describe the use of cartilage extracellular matrix and bone marrow aspirate to augment this procedure in hopes of producing a more hyaline-like cartilage with improved wear characteristics.