Chondral lesions of the knee can occur secondary to limb malalignment, as well as a variety of other reasons. To address these interrelated problems, a high tibial osteotomy with concomitant osteochondral allograft transfer may be performed for those that have limb malalignment. Larger, full-thickness cartilage defects, which can be caused by limb malalignment, have proven to be particularly challenging to treat. This is my technique for multicompartmental osteochondral allograft transplantation with concomitant high tibial osteotomy for two focal cartilage lesions in the knee.