Thirty patients with deep osteochondral lesions of the talus were randomized to receive either mosaicplasty (n=15) or an all-arthroscopic technique using scaffold and autograft bone from the tibial plafond (n=15). The primary outcome of interest was clinical improvement measured by the AOFAS ankle-hindfoot score. Secondary outcomes included VAS pain scores and radiologic outcomes based on MOCART scores. Outcomes were assessed at 6 and 12 months postoperatively. Overall, the results of the study revealed that both groups had significant improvements in AOFAS and VAS scores, with no statistically significant difference between them. Radiological MOCART scores were also similar, though the all-arthroscopic group showed superior outcomes in subcategories of “border integration” and “repair tissue structure.” These findings suggest that both techniques are safe and effective, with the all-arthroscopic method offering potential technical advantages.