Sixty patients with osteochondral lesions of the talus (OLT) were randomized to receive arthroscopic microfracture surgery alone or arthroscopic microfracture surgery plus atelocollagen augmentation. Outcomes of interest included pain on a Visual Analog Scale (VAS), proportion of patients pain free during physical activity the Hannover Scoring System, the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score, quality of cartilage regeneration according to the magnetic resonance observation of cartilage repair tissue (MOCART) score, and the International Cartilage Repair Society grade. Outcomes were assessed 2 years post-operation. No statistical significant differences in VAS pain scores, Hannover Scores, or AOFAS scores were observed between the two groups (p<0.05 for all). However, MOCART total scores were statistically significantly in favour of the atelocollagen supplementation group compared to the control group (p=0.018). Specifically, the MOCART sub-scores for surface of repair tissue (p=0.008) and signal intensity of repair tissue (p=0.005) were statistically significantly in favour of the atelocollagen supplementation group. More patients in the atelocollagen supplementation group were pain free during physical activity compared to the control group (50% vs. 22%, p=0.048).