Chondral delamination, characterized by separation between the articular cartilage and subchondral bone, commonly affects middle-aged adults and can evolve into cartilage defects. Management of extensive chondral delamination presents a significant challenge, particularly in preserving the delaminated yet structurally intact cartilage. Despite its clinical importance, there is no standardized treatment protocol for this condition, and there are few long-term follow-up studies of its surgical management. This case report presents the long-term clinical and radiological outcomes of a novel combined surgical approach for large chondral delamination in a neutrally aligned knee, and discuss the benefits and potential complications of this treatment strategy. In conclusion, autogenous osteochondral transplantation combined with medial opening-wedge high tibial osteotomy shows excellent long-term functional outcomes for large medial femoral condyle chondral delamination.