Knee osteochondral lesions can be debilitating. Multiple procedures have been used to manage these defects. Osteochondral autograft transplantation is one such option. Reported complications include donor-site morbidity, failed osteointegration, size mismatch, and incongruency. In this article, we report a case of graft incongruency of the medial femoral condyle that resulted in a full-thicknes...