Abstract [Objective] To study the effect of microfracture and osteochondral transfer in the treatment of small area of osteochondral lesion of talus. [Methods] The data of 49 patients with small area (0.8-1.2cm2) of osteochondral lesion of talus admitted to our department from June 2014 to July 2018 were retrospectively analyzed. According to the different intervention methods, they were randomly divided into microfracture group and transplantation group.The visual analogue scale (VAS), the ankle-hind foot score (AOFAS) of the American Society of Foot and Ankle surgery, the ankle activity score (AAS), and Berndt's and Harty's X-ray based ankle osteochondral lesion criteria (Berndt's stage) were compared between preoperative and final follow-up. [Results] All 49 patients were followed up, and the mean follow-up time of the microfracture group and the transplantation group was (17.2±3.2) and (17.5±3.6) months respectively. At the last follow-up, the VAS score, AOFAS score, AAS score, Berndt stage criteria and other indicators of the microfracture group and the transplantation group were significantly improved compared with those before surgery. Compared with the microfracture group, the effect of the transplantation group was more obvious, and the differences were statistically significant. [Conclusions] For small area (0.8-1.2cm2) of osteochondral lesion of talus, both microfracture and osteochondral transfer can relieve the pain and improve the function of the affected limb. Osteochondral transfer is more effective and worthy of clinical application.However, the number of cases in this study is small and the follow-up time is short, so the long-term effect needs to be further observed.