The management of tibiotalar arthritis remains a clinical challenge. Conventional treatment relies primarily upon arthrodesis or prosthetic arthroplasty. Fresh osteochondral total ankle allograft transplantation has been reported in limited cases. We report the case of a 42-year-old male who underwent a tibial refrigerated osteochondral allograft and a talar refrigerated osteochondral mosiacplasty. At 66-month follow-up, the patient demonstrated no limp with walking and was able to participate in tennis and snow skiing with no pain. His Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, total WOMAC score, and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score were 0, 94, and 98, respectively. The final radiograph showed complete integration of the allograft with mild joint space narrowing. Osteochondral allografting for ankle arthritis may be considered an option in select patients.